The OT Magazine – Mar / Apr 2021 by 2A Publishing

THE

MAGAZINE Issue 39 | Mar/Apr 21 | Improving Independence

Spring has sprung Add a sensory angle to your Easter egg hunt with our eggcellent messy and fun crafting activities

COLU M N S

PRO DUC T S

CPD

EVENTS

MENTAL HEALTH

About us

The Team

Editor: Rosalind Tulloch Staff Writer: Katie Campbell Designer: Fionnlagh Ballantine Production: Donna Deakin Sales: Danny McGonigle Contributors: Kate Sheehan, Otibho Edeke-Agbareh, Melissa Chieza, Jacob Holden, Esther Dark, Rob Henshaw, Emily Stuart, David Wilson

This month’s issue...

s the roadmaps are laid out to navigate us out of the pandemic, we can all start to feel cautiously optimistic about the months ahead. Having a finishing line in sight, coinciding with the arrival of spring and Easter, feels appropriate as it all represents forms of new life and new beginnings. Let’s hope there are no more setbacks this year.

Get in touch 2A Publishing, 20-23 Woodside Place, Glasgow, G3 7QL 0141 465 2960 ot-magazine.co.uk The OT Magazine @ot_magazine

Disclaimer

The OT Magazine is published by 2A Publishing Limited. The views expressed in The OT Magazine are not necessarily the views of the editor or the publisher. Reproduction in part or in whole is strictly prohibited without the explicit written consent of the publisher. Copyright 2021 © 2A Publishing Limited. All Rights Reserved. ISSN-2056-7146

Easter offers a great opportunity to get kids crafty and messy with some Easter-themed sensory activities. From marshmallow fondant slime to making chocolate treats in the kitchen, these activities will keep younger patients engaged and excited. We have some fantastic contributions from OTs this issue. We hear how Otibho Edeke-Agbareh uses her OT skills as the humanitarian services manager at Kenyon International Emergency Services when responding to disasters across the globe. Esther Dark addresses the challenges of helping those experiencing binge eating disorder and we hear from two OT students reflecting on their experiences of learning over the last year. Did you know that OT can be traced back to 100 BCE? Neither did we until we did some digging. Read about this fascinating history on page 54. We also tackle the stigma around stomas, discover a new adaptive cycling hub and showcase a variety of products and services to aid independent living. We hope you enjoy this issue, don’t forget that we always welcome contributions, so if you would like to share your work or a reflective piece email ros@2apublishing.co.uk. Until next time, stay safe. The OT Magazine, Editor

SUBSCRIBE TODAY Further your career and enhance your CPD by subscribing to The OT Magazine

Subscribe for only £9.99 Go to: ot-magazine.co.uk/subscribe -magazine.co.uk

What’s inside 07 What’s New

Bringing you up to speed with all the latest news from the healthcare sector

13 It’s The Small

Things That Count

Kate Sheehan reflects on small acts of kindness

14 Disaster Response Otibho Edeke-Agbareh explains how her OT skills translate to emergency scenarios

18 Product Focus The latest must-have products on the market

27 22 Virtually Speaking,

This Works for Me

Melissa Chieza explores how she managed a virtual emerging placement and her diabetes

25 Day in the Life Meet Jacob Holden, an OT with video games charity SpecialEffect 4

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27 Binge Eating

Disorder

To mark Eating Disorder Awareness Week, Esther Dark writes on how to support clients living with binge eating disorder

32 The Stigma of

Stomas

Dispelling the myths and mysteries surrounding stomas

35 Product Focus More of the latest must-have products on the market

Product

Focus 35

38 Socially Conscious Does the social model of disability complement the person-centred approach of occupational therapy?

42 Rehab Support

54 The Ancient Art of

Humane Treatments

What was OT before it was OT? In Ancient Rome, it was the humane medicine of Asclepiades

Following Discharge 56 Taking Control

Therapies on Thames explain how they provide support services for people who require rehabilitation at home

45 Paediatrics Section We explore sensory activities for Easter, adapted bikes, and all the latest innovative products for younger clients

Where do OTs go when their clients need adaptations to get into the gaming community?

64 Blended Learning Second year OT student David Wilson shares his experiences of blended learning -magazine.co.uk

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We explore what’s happening in the healthcare sector, from new products and services to inspirational stories

What’s new? CHARITY HERO CAPTAIN

SIR TOM MOORE DIES AGED 100 The nation mourned the news last month that centenarian Captain Sir Tom Moore had passed away after being hospitalised with COVID-19 and pneumonia on 2 February. A veteran of the Second World War, Captain Tom (as he became to be affectionately known) rose to prominence in the shadow of his 100th birthday, as he began a charity walk for the NHS, aiming to complete 100 lengths of his garden with the assistance of his walking frame, with the goal of raising £1000 for NHS Charities Together. Starting on 6 April 2020, by his 100th birthday on 30 April, Captain Tom had raised a phenomenal £30 million. His passing was met with an outpouring of love and respect, with Buckingham Palace releasing a statement announcing that Queen

Elizabeth’s thoughts were with the Moore family. Prime Minister Boris Johnson called Captain Tom “a hero in the truest sense of the word,” saying: “In the dark days of the Second World War he fought for freedom and in the face of this country’s deepest post-war crisis he united us all, he cheered us all up, and he embodied the triumph of the human spirit.” In a statement from Captain Tom’s daughters, they praised the NHS for the care he had received, adding: “The last year of our father’s life was nothing short of remarkable. He was rejuvenated and experienced things he’d only ever dreamed of. “Whilst he’d been in so many hearts for just a short time, he was an incredible father and grandfather, and he will stay alive in our hearts forever.”

NAIDEX VIRTUAL Boost your CPD at Naidex’s free two-day virtual event. Taking place on 18-19 March the Naidex Virtual Event offers occupational therapists an opportunity to discover the latest solutions, practices and innovations from across the globe.

up meetings with exhibitors, demonstrations to watch, opportunities to speak to the experts and you can do it all from the comfort of your own home or office, completely free of charge.

There will be over 70 industry experts delivering leading online sessions and live online demos”

There will be over 70 industry experts delivering leading online sessions and live online demos, as well as a variety of cuttingedge suppliers. Similar to the physical event, this digital event will address the latest topics, trends and solutions in the independent living industry. There will be the option to set

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A group of occupational therapists and physiotherapists from across NHS Greater Glasgow and Clyde have developed a self-management information page for anyone recovering at home from an illness, including COVID-19. The information provided is suitable for patients who have been discharged from hospital, people experiencing ‘long COVID’ symptoms and even for those who have not had a hospital admission.

ROAD TO SELF-RECOVERY

The website includes links to resources that address areas like managing fatigue, easing breathlessness, increasing physical activity and looking after general wellbeing at home. It has been designed thoughtfully by OTs and physios to support any patients’ recovery from illness. nhsggc.org.uk

New Chief Exec for RCOT Earlier this year Steve Ford was announced as RCOT’s new chief executive, succeeding Julia Scott as she stepped down from her role last month after 15 years of service. Following her decision last year to step down as chief executive, the end of February marked the end of a long and successful career at RCOT. There has been an outpouring of farewells and support on Twitter thanking Julia for her dedication, support and commitment over the last 15 years, a testament to the impact she has had on many occupational therapists personally and to the profession as a whole. Steve Ford, who will take on the role of chief executive on 6 April, has been the chief executive at Parkinson’s UK for the last 15 years and has worked in leadership roles in the health and social care sector for over 30 years. Throughout his career he has worked closely with occupational therapists and he is excited to join the RCOT ranks, as he commented: “RCOT is a great organisation, full

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of great people, and I am honoured to be given the opportunity to help shape its future and that of the occupational therapy profession.

“Throughout my career, I have worked alongside many amazing occupational therapists. I’ve seen the difference occupational therapists make to people’s lives, in particular the vital role they play in supporting people with long-term health conditions. I am looking forward to raising the profile of the profession so that it receives the investment needed to ensure occupational therapists can play their full role in future models of health and social care. “I believe that the most important skill in a leader is listening, and from doing that comes ambition, focus and passion. My focus when I start in April will be to spend time with the team, volunteers and members so that I can build on my knowledge of the organisation and profession to better understand our future challenges and opportunities.”

schools across Barrow in Furness were partnered with mental health practitioners to talk to the children. The kids shared their feelings, hopes, wishes, and strategies for resilience to help shape the theme of the book. The book was designed to help parents and carers identify how their children are feeling and to offer suggestions to improve their emotional wellbeing.

MENTAL HEALTH RESOURCE BOOK A mental health resource book has been launched to help children, parents, carers and professionals to manage the emotions they have been experiencing through the pandemic. The book, titled Living in Lockdown – Our Children Remember, was created by Furness

Education and Skills Partnership (FESP) and was supported by local schools, Barrow Integrated Care Community and local third sector organisations, and funded by Barrow and Millom Primary Care Network. Children’s experiences of living in lockdown were captured as

Only Human Approach King’s College Hospital has been one of the first NHS Trusts to use a new concept known as ‘nudge theory’ to support frontline staff to cope with their roles throughout COVID-19. #OnlyHuman is the project and it has been developed by the Health Innovation Network. Their

patient safety and experience team have taken a behavioural science approach to supporting frontline staff and have worked closely with behavioural insights specialists to create a campaign that reflects this. The research involved in this approach recognised early on that

The cover of the book was designed by a school pupil and it represents two worlds; the world before the pandemic and the world after. They commented: “The sky shows the brightness and happiness when everyone could see their families and friends, the sea, showing the darkness, the deeper you dive, the darker it gets until you are rescued and can again see the sun shining bright.” Copies of the book will be made available to all local schools, through the NHS and to organisations working with children. Email neil@fesp.co.uk to obtain copies of the book. NHS staff struggled to recognise signs of stress in themselves, but were much better at spotting these signs in their colleagues. The campaign takes a peer to peer approach to support your peers at a time when emotional and physical wellbeing may have been neglected. You can download a complete set of resources at healthinnovationnetwork.com.

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OTS DELIVER INCLUSIVE FOOTBALL REHAB Sport for Confidence have teamed up with Colchester United Football Club to deliver inclusive football sessions to adults that face barriers to participation. The weekly sessions take place outdoors at Shrub End Community Centre and see coaches from Colchester United and Sport for Confidence running a range of drills and activities designed to help skill development, but the main focus is always on fun and enjoyment. An OT from Sport for Confidence

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is present at all sessions ensuring all participants are included and supported to achieve their own personal goals, and at the beginning of each session each participant is offered the chance to take part in an OT-led workshop focusing on employability skills and confidence building. This approach allows attendees to practice their skills during the sessions and following the programme the OTs will support the participants to access employment opportunities.

Sophie Garratt, occupational therapist and programme lead at Sport for Confidence, says: “Official statistics report that the UK employment rate for disabled people is just 47.2%, compared with a rate of 80.3% for nondisabled people. We hope, through this initiative, we can work with our participants, building their confidence and providing them with the skills and tools they will need to help them join or re-join the workforce.”

The Motability Scheme enables disabled people to lease a new car, scooter or powered wheelchair without the worry of owning and running one. Parents and carers can drive on behalf of the customer. The vehicle should be used by, or for the benefit of, the disabled person.

Making life easier for disabled people

“Learning to drive and having my own car has helped tremendously. I have gained a new independence and the freedom to move around easier.” Allison

Who can join the Motability Scheme? Your patient may be able to join the Scheme if they receive one of the following: • Higher Rate Mobility Component of Disability Living Allowance (DLA). • Enhanced Rate of the Mobility Component of Personal Independence Payment (PIP). • War Pensioners’ Mobility Supplement (WPMS). • Armed Forces Independence Payment (AFIP).

What’s included on the Motability Scheme? Insurance Breakdown assistance Servicing and repairs Tyres and battery replacement

To find out more about the Motability Scheme visit motability.co.uk or call 0800 093 1000 (quote OT Magazine)

How Motability, the Charity can help Motability is a national charity which oversees the Motability Scheme. Motability may be able to provide charitable grants towards vehicle Advance Payments, adaptations or driving lessons to support disabled people who would otherwise be unable to afford them.

Do you have patients that could be eligible to join the Motability Scheme? Visit our website to order your free information pack

motability.org.uk/advisors or call 0800 500 3186 Motability is a Registered Charity in England and Wales (No.299745) and in Scotland (No.SC050642). Motability is authorised and regulated by the Financial Conduct Authority (Reference No.736309). All cars, scooters and powered wheelchairs provided under the Motability Scheme are leased to customers by Motability Operations Ltd, who operate the Scheme on a contract basis for Motability. Motability Operations Ltd is authorised and regulated by the Financial Conduct Authority (Reference No.735390).

Kate Sheehan Director, The OT Service

The OT Service provides high quality advice, consultancy and training to manufacturers, retailers and service providers. It also provides occupational therapy clinical services in housing and equipment to case managers, solicitors and private individuals via its handpicked network of occupational therapists. For more info email kate@theotservice.co.uk

IT’S THE SMALL THINGS

THAT COUNT

here has been lots of time to reflect over the last year, and to realise how important friends are; the benefits of a chat, a listening ear, and a hug - that time with friends is precious and we must remember we will be able to do it again, hopefully soon.

But there are some friends and colleagues we will never be able to hug again who have lost their lives to COVID-19, like Vivek Sharma, a clinical lead in falls management in Kent - our condolences to his family and friends, and to all affected by COVID-19. There are also colleagues and friends who have died from conditions unrelated to COVID-19 this year, and their loss is mourned just as much. I was fortunate to grow up in the rural outskirts of Manchester, in a small village called Mellor. There was a gang of kids who used to get off the bus together and walk over the fields to get to our houses; we often stopped on the way at the vicarage to have tea and biscuits as this was the home of my good friend Liz Phillips. Liz left school at 16 and worked in the hospitality industry, and we used to meet up during holidays to catch up on our news. On qualifying I worked in London and we once met up in a pub in Baker Street, Liz announced she wanted to become an occupational therapist, as she said my passion and love for the profession was infectious and from that drink, she started the long

process of getting the necessary qualifications to go off and train.

Liz trained at the London School of Occupational Therapy, now known as Brunel University, it was such a joy to hand over all my textbooks to her and it was lovely that she would occasionally phone in a panic with an assignment that she was struggling with, and we would laugh about it, and I hope in a very small way I was able to help. Once qualified she travelled, and eventually moved to the USA and worked in various qualified and nonqualified roles before finally settling in Florida. She worked with children on the autistic spectrum; she loved her chosen career and was well respected by her colleagues.

friendships: Zoom a friend, drop some cake off at their door, send a card, text a thank you message for just being there, WhatsApp a meme or just be old fashioned and pick up the telephone for a blether, because these small things might make all the difference to them and you.

Remember we are social beings, and the lack of social contact over the last year continues to have a significant impact on our mental health. Let’s practice what we preach and look after ourselves and take care of each other, especially those precious to you. Rest in peace Liz, your memory will live on in all those people whose lives you touched in your much too short life.

Unfortunately, Liz lost her battle with cancer in early February. Sadly, none of her family were able to be with her, however she was surrounded by her friends and her partner, Mark. Her death has made me appreciate my friends even more; their love, kindness, hugs, calls and cards make all the difference to my life and remind me that the small acts of kindness can make a huge difference. It is important that we grieve for those we have lost and give ourselves time to remember the good times and the joy those friendships have given us.

...the small acts of kindness can make a huge difference

So, in these very difficult times, take time out of work to give yourself space to enjoy and celebrate -magazine.co.uk

DISASTER RESPONSE Otibho Edeke-Agbareh is the humanitarian services manager at Kenyon International Emergency Services. Here she discusses how she utilises her OT skills in her role and what responding to disasters has taught her about the occupation of living

he World Federation of Occupational Therapy (WFOT) simply stipulates that the primary goal of occupational therapy is to enable people not just to participate in activities of everyday life, but to engage in purposeful, meaningful living. This very bedrock of our profession has seen us through over 100 years of service globally. It is little surprise that the solidifying of OT was born out of two major global incidents, namely the First and Second World Wars. It is in the midst of a disaster or incident that OT is needed the most. Disasters, whether manmade or natural, bring a significant disruption to everyday life. This includes loss of life, injury, damage to communities and also economic loss. The effects of an incident can be widereaching and devastating. We experienced all of these last year, simultaneously and without warning, through the global COVID-19 pandemic. We saw, and still see, mass fatalities and economic down turns with many out of work. There have been school closures and lockdowns, which although necessary, have broken down social networks and support systems. In the midst of this, OT has never been more needed. It is in the midst of seeming chaos, uncertainty and disruption that OTs can bring routine and purpose into the day through the use of meaningful occupation, and through seeing people holistically.

Kenyon is an organisation with over 100 years of responding to some of the world’s largest disasters 14

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DISASTER PREPAREDNESS AND MANAGEMENT I integrate my OT training and experience into every element of my work as a humanitarian services manager at Kenyon International Emergency Services. Kenyon is an organisation with over 100 years of responding to some of the world’s largest disasters, such as the attacks on 9/11, the Boxing Day Tsunami, the Haiti earthquake, Grenfell Tower and the COVID-19 pandemic, to name a few. At Kenyon, a holistic approach is taken when it comes to incident response. For this reason, we provide everything from the recovery of human remains and family assistance to crisis communications support. As the head of Kenyon’s family assistance programme, I incorporate every element of the WFOT’s position statement on an OT’s role within this sector. This is because OTs - due to our training and clinical experience - have so many transferable skills. Skills that I use every day. I liaise with organisations and international and local authorities to review emergency plans, ensuring they meet the needs of everyone who might be impacted by an incident. I provide training and advice so that resilience is built within communities. Lastly, when called upon, I deploy with a group of international team members (TMs) to provide family assistance after an incident. I lead special assistance team members (SATs) to provide direct and timely support to families and those directly affected. Normally, family assistance is provided within a Family Assistance Centre where routines are set via meal times and scheduled meetings with their SATs, dedicated rooms where children who are impacted can play, family briefings which help to keep families informed on the incident, and practical help with day-to-day needs. OTs lend themselves to the SAT role as we understand the use of normalising routines and meaningful activities in order to help ground people to deal with life ahead of them.

role is to look at them and ask what they need and how we can provide the light to guide them to what will be their new normal.

OTS TIME TO SHINE With the establishment of long COVID-19 and the mental health impact of living through a pandemic lasting far into the future, OTs must see themselves as part of the solution. Working with international organisations, local authorities and healthcare systems to provide a unique type of rehabilitation - not just to patients but to humanity in general. We will all need to learn how to find new meaning in life again as we adjust to our new normal. I would like to end this article with a call to action to all OTs. There are few professions that tailor their whole premise to helping people holistically, leaving no aspect of a person irrelevant. It is our job as OTs, no matter what our work setting, to be that light that reminds people that everyone deserves to live a life that is full of meaning and purpose. That this is not just a necessity but a human right. This, above all things, is what responding to disasters has taught me about the occupation of living.

ABOUT THE AUTHOR

Otibho Edeke-Agbareh (MSc, BSc) is the humanitarian services manager at Kenyon International Emergency Services. Before this she served both the NHS and the private sector as a specialist occupational therapist in major trauma and orthopaedics. She has significant humanitarian experience, deploying to different countries throughout her career. She is a member of the UK Emergency Medical Team (UKMET) and was deployed to Gaza in 2014 as part of a rehabilitationled team. If responding to disaster and supporting families sounds of interest you can visit kenyoninternational.com.

How can OTs, who typically work in hospitals and communities, turn their hand to responding to global disasters? The answer is woven into the story of a mother who lost her son unexpectedly in a country in which she did not reside. In this instance the answer is simple. It is to see the mother and this incident in a holistic manner that reaches far beyond bereavement support. It is facilitating her travel to the country where her son died, organising a site visit so she can go and pay her respects at the place where he passed away, organising a memorial service, providing her and those directly involved with mental health support and liaising with authorities in order to have her son repatriated home for his funeral. All the skills we honed as OTs, completing complex discharge plans and liaising with a multi-disciplinary team, just used on a global scale. That’s the thing about OTs in the field of DP&M - OTs still use all their taught skills. This time it may not be a patient but a family who has lost a loved one, or a survivor of an incident. Our

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Here at Made For You Softer Foods, we believe that everyone should look forward to a tasty, nutritionally balanced meal. That’s why we have created Made For You Softer Foods.

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Preparation of texture modified food for people with chewing or swallowing difficulties can sometimes be challenging which is why we have a large range of meals to suit people who have dysphagia. All of our softer foods ready meals are made to be cooked straight from frozen to make them easy and quick to prepare. Our meals can be cooked in the microwave or the oven, just be sure to follow the cooking instructions on each dish.

ade For You Softer Foods from Oakhouse Foods is a softer foods range of frozen ready meals. We offer a wide range of meals, that are beautifully shaped and made with quality ingredients to provide a nutritious and satisfying meal, suitable for people who experience chewing or swallowing difficulties know as dysphagia

All our meals have been prepared in line with the IDDSI Framework and are suitable for the following levels: Level 4 Puréed diet Level 5 Minced and Moist diet Level 6 Soft and Bite-Sized diet This means all our meals are safe and compliant with the IDDSI level that has been advised by a speech and language therapist. We appreciate that the appearance of our meals is of importance as this helps to make the meal more visually appealing and appetising. It is common for people with dysphagia to have a reduced appetite and we understand that the visual appearance of meals can help to increase appetites and subsequently encourage greater food intake at mealtimes. Our range of meals have also been developed to ensure the nutritional content will meet the nutritional needs of someone who has been advised to follow a texture modified diet. Research has shown that up to 50% of people with dysphagia are malnourished or at risk of malnutrition. There could be numerous reasons for this, including a reduced appetite or the inability to consume 16

At Made For You, we offer a delivery service that cares, making it easy and convenient for our customers to eat delicious meals which can be delivered directly and safely to their homes. This helps them if they cannot leave the house or go to the shops. Plus, people love to use our service, as they can rely on a regular delivery of good quality meals, directly to their door, by their friendly local Oakhouse Foods delivery drivers. Want to know more about the Made For You range? Take a look our fantastic new Made For You website at www.its.madeforyou.co.uk. Prefer to speak to someone? Our wonderful team are ready to take your call on 0333 433 0293.

Delicious Softer Foods Ready Meals Our Made For You softer foods range offers a range of texture modified frozen meals suitable for those who experience chewing or swallowing difficulties.

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Product FOCUS Every issue we bring you the latest products from across the market to help you improve the lives of your clients

PARAVAN PR35S

Meet the smallest standing powerchair currently available in the UK. With a chassis width of just 57cm and a maximum user weight of 80kg, the PR35S is a genuine paediatric sized powerchair for children and adults of smaller stature. Standard powered features include lying, seat lift, Tilt in space with anterior tilt, recline backrest with incorporated anti-sheer and elevating leg rests. precisionrehab.co.uk | 01256 300111 2

GLASSOUSE

This clever device is a wearable mouse that individuals can wear just like glasses to operate a computer, smart TV, tablet or phone. Ideal for those with limited upper mobility, it links to devices through Bluetooth and the on-screen pointer is moved by small head movements. A mouse click is performed using a switch and there are many to choose from depending on your client’s needs. activehands.com | 01564 702 255

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BOOK STAND

This stylish bamboo book stand is ideal for holding books, magazines and even tablets. The springed arms have rubber ends to allow them to hold books and devices in place without marking them and the stand itself can be adjusted to six different angles to ensure users can find their optimum reading angle. amazon.co.uk 4

SMARTCARE LEVER

AKW have launched a smart electric shower with an easy-to-use lever. Designed for anyone with visual impairments, dexterity problems or mobility issues, this simple shower can be installed easily with no fuss. It has audible temperature control clicks, large blue and red symbols and a large back-lit power button.

akw-ltd.co.uk | 01905 823 299 5

BRAILLE RUBIK’S CUBE

Designed to allow individuals with a visual impairment to enjoy the frustration of trying to solve a Rubik’s cube. Each cube has one of the colours, either red, green, blue, yellow, white or pink imprinted on it in Braille, allowing anyone with vision loss to try their hand at this age-old, almost impossible game. yankodesign.com

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NEW FOOTWEAR COLLECTION

Cosyfeet, the specialists in footwear for swollen feet, have launched their new collection for spring. It’s packed full of fashionable styles and colours, including on-trend spots, metallics and animal prints, proving that extra roomy footwear can look contemporary and stylish whilst accommodating swelling with ease. This range of shoes is designed to fit and flatter swollen feet with ease. cosyfeet.com | 01458 447275 7

INFO BADGE

For individuals who are living with compromised immune systems and healthcare problems, this is a perfect badge to wear to let people know. In these difficult circumstances with easing restrictions, face masks and social distancing it can be hard to explain individual health concerns to others, this badge helps to alleviate that pressure.

NotSoppyStore on etsy.com 8

PERSONALISED LAP TRAY

Cushioned lap trays are great for comfort and for practicality at mealtimes. These handmade wooden framed lap trays also offer the opportunity to be personalised with a family photograph or memorable scene. A great idea for a gift for an older relative or friend. bluebadge.co.uk

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Virtually Speaking, This Works For Me BY MELISSA CHIEZA

Melissa Chieza explains how virtual emerging placements offered her both the experience and the adjustments she needed to become an OT while managing her diabetes and the global pandemic

n March 2020, I had to start shielding due to my two long term conditions, one of which is diabetes. I switched from an in-person role to a virtual emerging placement in a similar specialism in order to complete my final placement hours and become an occupational therapist. According to Boyle et al: “diabetics make up to three hundred diabetic related decisions everyday.” This decision process occurs from the moment I wake up to the time I go to sleep; I have to consider the activities involved in my day, from looking at the nutritional labelling in the food and giving the correct amount of insulin, to any physical activity involved and the impact on my body when I need rest. By working from home, I did not have to be very restricted as I could continue to plan my routines and activities from home. As an active member of the online OT Twitter community, I attended a webinar by another student who had organised a virtual placement, Georgia Vine and Margaret Spencer. This gave me the motivation and encouragement to carry this out myself. In the webinar, Margaret Spencer gave me Louise Kermode’s details: I made contact and she was willing to assist in this. I discussed the idea with my university placement team, and how I would meet my goals working from home. The placement educator Louise Kermode and I made sure to discuss reasonable adjustments that would support me in managing my health whilst working from 22

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...diabetics make up to three hundred diabetic related decisions everyday

home, which included being able to schedule regular breaks. Completing a virtual placement allowed me to observe my blood glucose patterns simply by looking at my Apple Watch through my Dexcom app, which was helpful as accessing personal devices is often discouraged in typical placement settings. If I were in a hospital environment, I may not have been able to use my Apple Watch due to infection control risks. The positive impact on my health management during this virtual placement experience has been eye-opening, and I now feel more prepared to propose virtual working within future employment in the NHS. The virtual placement has left a lasting impression on me and I feel virtual placement should be made permanently available to future students as an alternative to offering traditional placements. I still needed to complete 1000 hours, and the placement was virtual, but it was also role emerging: I would be the only occupational therapist in a mental health team managed by social workers. It was my role to carry out rapid telephone assessments to ensure that the client was supported to complete meaningful activities of daily living to aid their wellbeing during coronavirus.

...sometimes it can be difficult for clients to open up when on the telephone or virtual platforms

The disadvantage of this is that although I was the first point of contact, I missed seeing the patient going through all the steps of the OT process. Much of this related to signposting or referring onwards to other services within the community. The services adapted ways for clients to build on having more daily routine through weekly activities via zoom calls. I looked at it from a physical and mental health point of view when completing my assessment. It has taught me how clients feel when completing virtual assessments, as sometimes it can be difficult for clients to open up when on the telephone or virtual platforms, as some clients feel uncomfortable to disclose this information and would need more time to build a rapport. Working virtually on placement helps you develop skills necessary for becoming an autonomous practitioner, and it helps you to prepare for preceptorship as a newly qualified occupational therapist. My situation was instigated by the pandemic, but some elements of virtual healthcare will likely continue in the future, and provide benefits for occupational therapists when managing their own health needs. Building a therapeutic relationship over the telephone has been difficult, as I was not able to see the client’s facial expression, visual cues, or interactions to better understand verbal communication. As an occupational therapist in learning disabilities, I tried to counter this by establishing a rapport through helping the client feel prepared before our meeting. Before meeting the clients I send them some guidelines, especially if we are completing an observation of activities, for example, making a meal or performing a domestic task. These guidelines prepare the client and relatives, giving them knowledge on what to expect on the day, but also allowing them to think about how they want to introduce themselves to me. Then, when the assessment takes place, I spend the first 10 to 15 minutes building a therapeutic rapport with clients through a virtual platform. Follow Melissa on Twitter @melissa_chieza.

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RECRUITING NOW! If you’re an ambitious Occupational Therapist looking to make a positive career change, we have excellent opportunities for you to become a qualified Disability Assessor. • • • •

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n i y a d A . lden o H b Jaco is a specialist t a

ist a Jacob therap e l a n ect. H atio cialEff occup e p S oan d f the l y calle o it t r r a a h c ere as p 18 wh orked ce 20 has w in s e to team peopl d e l b library a es. ists dis o gam he ass e id v s acces

What is your current role and how long have you been in it? I am a specialist occupational therapist at a charity called SpecialEffect where I have been working since November 2018. I am part of the loan library team where we help people with physical disabilities to play video games via specialised equipment. Each gaming setup we create is completely tailored based on the individual’s physical movement and gaming preferences. We work with all ages and any physical disability, such as cerebral palsy, muscular dystrophy, brain injuries and stroke to name a few. Traditionally I would be travelling all over the UK with my colleagues to help people play video games. We would take a large amount of gaming equipment and trial it with the individual until we found a setup that is right for them. However, COVID-19 has impacted the way we work. We have adapted by providing our services through video calls where we have a discussion involving the individual wanting to access games and gauge what gaming equipment we think they may benefit from. We then post the equipment and have a follow-up call to advise them how to set everything up. We also offer a lifelong service

. f o e f i l e th

Each month ..

we talk to a differen occupati onal thera t pist to see wh at a typic a l day is for the ma a little mo nd explain re about their role.

Jacob Holden

as new games and consoles may come out or someone’s condition may progress in which we would then need to adjust their current setup.

Describe a typical day... We always do gaming assessments in pairs of OTs, so we discuss the individual and prepare some ideas that we could suggest based on the initial information we have. We often have several assessments with people all over the UK and sometimes internationally each day to help them with gaming. These could be initial assessments where we’re helping someone who has never played games before due to their condition or followup assessments by helping them play a more complex game which requires more buttons or joysticks to play. We need to have an extensive knowledge of games across all platforms, such as PlayStation, Xbox, and Nintendo Switch, so we research games on a daily basis to see how many buttons and joysticks are required to play and what settings could be useful to make gaming easier.

What is the hardest thing about your role?

With COVID-19 affecting our capacity to do face-to-face assessments, we are not having the hands-on experience with setting up equipment ourselves and are instead instructing people how to do it when doing our video calls. Nothing can replace an in-person assessment where we develop a rapport with an individual and get to know them more naturally, as well as try out several pieces of equipment in a single session rather than posting out that we think may work and waiting to hear how they get on.

What is the best thing about your role? There are two things that spring to mind. The first is how instantly rewarding the immediate positive feedback is when we help someone with gaming. Their smile says it all, knowing that they are able to play a video game after not being able to play due to their condition. The second is being able to help people get involved with one of my biggest passions. I’ve been a gamer for over 20 years and I feel incredibly lucky to be in a job where I can combine work and play. 25

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Binge Eating Disorder BY ESTHER DARK

1-7 March marks Eating Disorder Awareness Week and this year’s theme focuses on binge eating disorders. OT Esther Dark contemplates how occupational therapy can be utilised to help and support individuals who are affected by binge eating disorder

ne quarter of the requests for help received in November 2020 to BEAT - the UK’s national eating disorder charity - were related to binge eating disorder (BED), triggering this year’s Eating Disorder Awareness Week theme, which is shining a light on this often misunderstood, but prevalent eating disorder. BED affects approximately 1,398,000 people in the UK and is the most common eating disorder; three times more common than anorexia and bulimia, but often the most misconstrued eating disorder according to the charity BEAT. Shockingly, however, only 28.4% of individuals with BED are receiving treatment for their disorder. BED is typically characterised by consuming large quantities of food in a relatively short time frame, typically in secret and followed by strong feelings of guilt, loss of control or disgust. Unlike bulimia nervosa which may use compromising strategies such as vomiting or laxative abuse to purge the binge, BED typically does not follow this pattern, although some individuals may fast between binge episodes and binges can also feature as part of bulimia nervosa or anorexia nervosa binge-purge sub-type. Weight stigma,

discrimination and stereotyping are rife in our society and BED is often wrongly synonymised with emotional eating, yo-yo dieting or compulsive eating. Whilst body size is not directly related to BED, movement between weight gain and weight loss is commonplace in BED; therefore, practitioners cannot assume individuals with larger body weights have BED, just as they cannot presume those who weigh less do either. Occupational therapists have a key and unique role in addressing the impact of eating disorders and providing occupation-focused interventions to support recovery. Despite playing a unique role in the treatment of eating disorders, lack of research within this field has left the profession with a gap in understanding. It is imperative that as occupational therapists we deepen our understanding of BED at both an individual and professional level: the implications BED can have upon one’s occupations and how individuals experience their illness to provide client-centred care, but also on a societal level: improving understanding in order to reduce societal stigma, the shame individuals experience and ensure more people with BED are able to access timely help and support.

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FACTS

Here are some facts about BED, with some reflective questions occupational therapists can consider: Individuals with BED have poor emotional regulation Research into BED has advanced, and it is now understood that binges are not simply characterised by mere physiological urges due to states of starvation but are often engaged by the individual for comfort, to fill an emotional need, or a means to numb overwhelming negative emotions. Many psychological models propose binge eating is preceded by negative emotions in the form of depression or distress and is conceptualised as a means to escape from negative emotions. How can occupational therapists support individuals who experience BED through developing better emotional regulation, mindfulness strategies and address the underlying feelings beyond the outward symptoms?

The occupations of BED serve as a purpose The behaviours marked by BED are not arbitrary and random, but serve a specific purpose, and can be viewed as positive, coping strategies for individuals, temporarily relieving states of adverse emotions. Elliot (2012) understands eating disorder behaviours can be occupations in themselves, and highly meaningful for individuals, providing identity, routine and structure. Therefore, how can occupational therapists seek to understand the meaning of BED behaviours? And furthermore, how can therapists support individuals develop greater self-awareness and insight into these behaviours?

BED affects all aspects of an individual’s occupations

BED behaviours are addictive in nature Bio-behavioural and neurological evidence reveals the connection between highly palatable foods rich in sugar, fat and salt bearing a similar addictive nature and effect to that of cocaine and alcohol, which produces dopamine, signalling changes in the brain, which promote escalation and desire of food intake. If BED is addictive in nature and is not something individuals can simply “snap out of”, then recovery may not be as straightforward as we may hope or assume. How can occupational therapists support individuals address ingrained habits and patterns and challenge our understanding that BED is not a fad or a phase, but that recovery may be a gradual process, which requires patience and understanding?

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Due to the all-encompassing nature of eating disorders, evidence reveals individuals have impaired daily living skills, as their lives become dictated by the eating disorder rules such as dieting, exercise and obsessivecompulsive routines. Self-care tasks may be increasingly difficult to engage due to negative self-esteem and poor body image; whilst leisure activities can be exasperated by poor concentration. Occupational therapists can provide experiential and occupational-based activities which can enhance performance skills, leading to improved self-identity - the key to this is supporting individuals to develop the motivation to engage in adaptative occupations. How can we support and motivate individuals with BED during their recovery? Resistance to change is common in eating disorders, but evidence reveals motivational interviewing can support individuals with anorexia nervosa, and also has promising efficacy for BED.

BEDs have serious health consequences

Individuals with BED have low self-esteem Individuals with BED are also marked by low selfesteem. Individuals with eating disorders are often highly self-critical and have low self-worth, influencing their ability and motivation to participate in occupations. Occupational therapists have been identified as pivotal in addressing poor body image and increasing motivation. How can therapists build an individual’s self-esteem and self-efficacy away from the disorder and through healthpromoting occupations?

BED can result in multiple health risks associated with obesity, including high blood pressure, high cholesterol levels, heart disease, secondary diabetes and gallbladder disease. How can occupational therapists address the physical side-effects of BED in a client-centred way, not just through punitive exercise regimes? Occupational therapists need to consider environmental factors and the resources available to individuals with BED to seek support and address associated physical health consequences of their eating disorder. Hopefully this Eating Disorder Awareness Week, we can abandon simple solutions, and blanket approaches and views regarding BED, and consider how BED can provide meaning and identity for individuals in order to truly see the person beyond the diagnosis.

Perverse western cultural messages complicate and confuse Western discourses which dichotomise food into “good” and “bad” foods, “healthy” and “unhealthy” and our society which is pre-occupied with body image, and dietary restraint, only complicate how individuals with BED perceive food as well as affecting our own biases and judgements as therapists. This contributes to the poor understanding amongst individuals, medical professionals, and the wider society of how to address BED, free of shame and guilt, and provide timely identification and treatment. The focus and obsession of health in our society promotes healthism and alludes that there may be something morally “wrong” or deviant with unhealthy people, this is compounded by messages communicated through weight management public health campaigns, such as the government’s recent weight loss campaign in the wake of the COVID-19 pandemic. Research proves that overweight people are treated differently to their counterparts; this unequal treatment is not codified in our NHS or services but emerges in complex and amorphous ways. How can we as therapists challenge our pre-conceived judgements of how people look, and avoid nutritional education based on what society deems “healthy”, but seek to provide meaningful solutions, which fit with an individual’s lifestyle whilst critically considering the collective culpability of eating disorders rather than only individual factors?

For more information visit beateatingdisorders.co.uk. You can follow Esther Dark on Twitter @EstherDark3.

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Take comfort Peter Wingrave, sales director at AAT GB, looks at how Hugga sleep solutions for postural care can deliver multiple benefits for client and carer

overnment guidance points out that research proves sleep systems reduce tone/tension, prevent or delay contractures and/or structural deformity, help improve respiratory function and avoidance of tissue damage. It further says the barriers to good postural care are: 1 Lack of awareness - by health and social care professionals, and others, that the consequences of body shape and distortion are avoidable 2 Lack of resources, often requiring specialist service 3 Lack of funding, the perception being such care systems are expensive. People who find it hard to move are most at risk of developing body shape distortions, which can impact on their existing conditions and/or lead to new physical problems: left unmanaged, it can create pressure on internal organs, pressure sores, contractures, scoliosis, spasticity, difficulty in breathing and eating. The clinical need for sleep/prone postural support systems is generally accepted: 1 Provision of external postural control and support 2 Reduction of tension within the muscles 3 Prevention of musculo-skeletal deformities and deterioration 4 Better posture and maintained muscle length 5 Reduction of pressure sores 6 Better implementation of carer intervention The challenge is finding the right solution: one that balances all the issues of properly supporting the client, being easy to use by the care support team (whether at home, day care or hospital environments), being accepted by the client, and being affordable.

The Hugga Sleep System was designed, in Britain, by leading neuro-physiotherapists for adults and paediatrics, to provide, cost-effectively and efficiently, the correct postural support in both supine and side lying. It offers a practical, easy-to-use solution that can be integrated into your care plan. The core system revolves around just eight key components that can be quickly and easily mixed and matched for each user as their needs change whether over a matter of hours or longer. The purpose-designed foam pads use hoop and loop grab fastening to fix and secure into place to correctly position and support the client (subject to relevant moving and handling procedures). Its ease of use and lack of complexity means it is simple to introduce elements and adjustments gradually to ease the body towards the correct alignment, with appropriate levels of abduction and extension. It can support a client and adapt with their needs throughout their life (or for as long as necessary). You can see it in action at youtu.be/gx6nikvKwsQ. Key for clients and carers alike, the Hugga system is breathable. The support pads wipe clean, and the base sheet is machine washable, so it is quick and easy to maintain optimum hygiene, no matter how long the system is used each day. Hugga prescription has resulted in demonstrable and measurable positive outcomes, both tangible and patient reported. Full details of the Hugga system, plus real-life client and healthcare professional experiences can be found in our brochure, and you can book a free, no obligation home assessment at aatgb.com/hugga.

Even when those issues are balanced, there are still practical considerations, particularly in these COVID times: keeping it hygienically clean, and ensuring client comfort.

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The Stigma of Stomas Dispelling myths and discovering the benefits of naming a stoma

atients who have undergone surgery for a stoma, whether this is due to bladder or bowel cancer, or an inflammatory bowel disease like Crohn’s disease or ulcerative colitis, can often struggle with the impact this has on their daily lives and the stigma that surrounds it. Occupational therapists are in a perfect position to help patients deal with the acceptance of a stoma.

WHAT IS A STOMA?

The Bladder and Bowel Community website describes a stoma as “an opening on the abdomen that can be connected to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of your body. It looks like a small, pinkish, circular piece of flesh that is sewn to your body. It may lie fairly flat to your body or protrude out. Over the top of your stoma, you will wear a pouch, which can either be closed or have an opening at the bottom. Your stoma has no nerve endings so you should feel no pain from it.” Many people require a stoma because they have experienced bladder or bowel cancer, and many people have lived with inflammatory bowel disease for years battling chronic and debilitating pain and either reach a stage with their disease where they must have stoma surgery, or they come to the decision on their own terms to reduce their discomfort and increase their quality of life. A stoma, while not a glamorous addition to a person’s body, can have a hugely positive impact on a person’s life. Some may have made their own decision to have stoma surgery and some may have had it thrust upon them, but the reality is that a stoma can be a life-saving and life-changing surgery.

A stoma, while not a glamorous addition to a person’s body, can have a hugely positive impact on a person’s life 32

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Most stoma bags and pouches are now made from odour-proof materials and many contain a filter for any gas that needs released STOMA STIGMA

NAMING A STOMA

There are many myths around stomas that are simply not true, but they remain in people’s minds and have a negative impact on their emotions towards stomas. Many patients associate stomas with older people, when in reality stoma surgery is performed on people of all ages. Another worry is that everyone can see that you have a stoma, again this is not the case as the slim pouch fits neatly under clothes and is relatively undetectable, so unless the wearer is choosing to reveal that they have a stoma then no one is any the wiser.

In 2018, two stoma nurses, Jane Cook and Jackie Hatton, noticed that many of their patients named their stomas. They decided to carry out a survey with their patients to find out more about why they did this.

The biggest concern that most people have is the fear that you can smell the contents of the stoma bag. Most stoma bags and pouches are now made from odourproof materials and many contain a filter for any gas that needs released, ensuring no smell can be detected by friends or colleagues at work or passers-by. When emptying the contents of the bag there will be an odour, but no different to anyone else using the toilet.

BODY POSITIVE The body-positive movement that we have witnessed online and through social media over the last few years has been incredibly empowering, particularly for people living with impairments. Instagram is flooded with young men and women proudly showing off their stoma bags in swimwear shots on the beach or just sitting casually at home. This has in turn sparked conversations about life with a stoma and opened up a platform for people to talk about their experiences and dispel all the myths that the general public associate with stomas. A quick Google search will bring up several blogs from young people living with stomas and most of them discuss the independence that having a stoma has brought to their lives. The overarching theme of these blogs is of humour and light-heartedness around their experiences, they have helped create a community where individuals living with a stoma can relate to the life experiences and find comfort in this. These blogs and social media channels can act as a form of therapy for the people writing them as well as for the people reading them.

100 surveys were distributed and 65 were returned. Of those returned 66% had named their stoma. Most people talked about the naming of their stoma as a way to make discussions more comfortable for them and for other people in their company. It was also highlighted that it helped children to accept the new addition to their parent or grandparent’s body by allowing them to name it. It has been shown that naming a stoma can help to bring acceptance and it can have a very positive effect on the relationship that the ostomate has with their stoma. It appears to have been something that many people arrived at a few months following their surgery, once they had come to terms with their experience. One survey respondent commented: “[I] named my stoma when I became happy with the situation; everything happened too quickly at the beginning for me to cope with. I was in shock at first, [my nurse] did mention that some people name their stoma—totally dismissed this at the time, but it must have rung a bell later; I remembered when I became more confident to give it a name.’ Colostomy UK recently published an article on their website that highlighted the top funniest names that members of the private Facebook group had given their stomas: 1 “Joey, as he lives in his mum’s pouch.” 2 “Louis V(uitton) the only designer bag I’ll ever own.” 3 “Donald… as he trumps quite a lot and is full of sh*t much like his namesake!” 4 “Rosie because it looks like a rosebud.” 5 “Clarice after my grandma. Who never went out without her pink lipstick and bag.” 6 “Tesco… bag for life!” 7 “Susie. I was initially told my colostomy was permanent so wanted to make best friends with her and thought that sounded a friendly name!!”

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The Server W from Rehasense UK features height and depth adjustable gutter armrests. Weighing just 9.5kg with a maximum user weight of 150kg, the Server W is one of the lightest forearm walkers available and can be used indoors and outside. It’s easily folded for transportation and the design also ensures the user walks with a better posture. Available in red or grey, it is a superb walking rehabilitation solution. rehasense.co.uk | 0333 220 0704 2

DOIDY CUP

The Doidy Cup is ideal for anyone who struggles to move their neck when taking a drink. Its slanted design minimises the need for excessive head movement making it easier to drink and stay hydrated. It has two handles for easy pick up and it is dishwasher and microwave safe. completecareshop.co.uk | 03330 160 000

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BUCKINGHAM COMPACT EASYWIPE

Designed by an occupational therapist, the Buckingham Compact Easywipe allows users to maintain their personal dignity as it enables them to hygienically clean themselves after using the toilet. The great thing about the compact version of this product is that it can be folded down and stored in a handy case to carry with you. onbuy.com 4

PANDA STEP

This stylish and simple step is made from bamboo which has a natural water-resistant quality, making it ideal for use in the bathroom. It can of course be used in any room in the house where extra height is required, and it is lightweight making it easy to move from room to room. An attractive and simple solution for everyday activities. abilitysuperstore.com | 0800 255 0498 5

GRAB RAIL TOILET ROLL HOLDER

The clever design of this product incorporates a stainless steel grab rail with a toilet roll holder. A practical and discrete solution for any bathroom, it looks great and will bring another element of safety for anyone who requires a little extra support when going to the bathroom. completecareshop.co.uk | 03330 160 000

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WHEELCHAIR BAG AND LAP TRAY

Trabasack’s Max is a large and luxurious wheelchair bag and lap tray in one. Designed for those who use their laptop frequently and when on the move, this bag allows wheelchair users to safely carry laptops and other items and work in comfort on business trips and outings thanks to the comfortable lap tray. disabilityhorizons.co.uk 7

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Active Hands have created a special gripping aid for smaller items like make-up brushes, pens, paint brushes and many more. It allows users to hold items at any angle required as the grip pad can be moved easily to accommodate. It consists of a neoprene glove and Velcro-on pad and it allows users to be more independent with daily activities. activehands.com | 01564 702 255

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SOCIALLY CONSCIOUS The holistic and socially-conscious approach of the social model of disability complements the person-focused interventions of occupational therapy

ny occupational therapist will be familiar with the concept of a model; they form the backbone of many approaches and interventions which allow OTs to help their clients achieve independence. The Kawa River Model, PEOP, biopsychosocial model - they all allow occupational therapists the theoretical framework required to approach a practical solution for their clients’ needs. When we speak about disability, there are two frequently contrasted models, each with a seemingly polarised view on how disability relates to the wider world. These are the medical model and the social model of disability. The former looks at disability from a biomedical perspective, and assumes that a disability will inherently reduce a person’s quality of life, but with the intervention of a medical professional, this can be reduced or “corrected”. The focus of the medical model is on the presence of a cure, and aims to bring disabled people closer to what is considered to be a “normal life,” with the medical professional’s ability to “fix” them being centred in the narrative. In the medical model of disability, someone might say that a person is “suffering” from their disability, and that chronic illness or injury would, in an ideal world, be “cured”. Many disability campaigners, including people like disability activist and broadcaster Mik Scarlet and charities like Scope, do not support the way that the medical model views disability, noting that it emphasises what is “wrong” with the person, and not what they need. On their website, Scope writes that they believe the medical model “creates low expectations, and leads to people losing independence, choice, and control in their lives.” Losing independence is the antithesis of occupational therapy, so what is the alternative? The social model of disability provides an alternative to the medical model of disability which complements the holistic approach of occupational therapy, and its patient-centred approach to care. The social model takes its roots from the disability rights movement in the UK, which further emphasises its holistic, “nothing about us without us” approach to care for disabled people. In 1975, the Union of the

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The mode social l roots takes its f disab rom the i move lity rights m UK, w ent in th e emph hich furth er a holist sises its i abou c, “nothin t g us” a us withou p t care proach to

Physically Impaired Against Segregation wrote that they believed it is society which disabled people by excluding them from fully participating in the world around them, a view that would form the backbone of the social model. It was disabled academic Mike Oliver who took these ideas and developed them into a well fleshed-out academic model, contrasting the individualistic nature of the medical model of disability to the communitybased social model of disability. His book, The Politics of Disablement, released in 1990, is considered one of the major moments in the social model’s adoption by wider society. From there, the social model has been adapted and expanded on to include people who live with learning difficulties or disabilities, and people with emotional or mental health conditions, too.

What approach does the social model of disability recommend, then? In simple terms, the social model tells us that a situation where a disabled person is not able to engage with society around them is not the fault of the disabled person, but society itself. As a comparative example, say a disabled person would like to enter a building where there are only stairs to reach the main entrance, but they are a wheelchair user, and cannot safely use the stairs. The medical model sees a disabled person unable to engage with “normal” society, and seeks to correct the problem by focusing on their ability to physically climb up the stairs. The social model, on the other hand, asks instead why the building does not have a ramp. In this scenario, per the social model, the person’s impairment continues to exist, but their impairment does

not prevent them from engaging with the rest of society, and their ability to simply enter a building. For non-disabled people, the social model is a way to challenge internal prejudices regarding disability, and unlearn thought patterns and stereotypes which are harmful to the disabled community. It emphasises that disabled people should always have equal opportunities and access: it challenges the notion that disabled people can’t have sex, work, live independently, or have children, and gives us the tools to confront any ableist ideals which we may have inadvertently learned throughout our lives. The social model of disability is not without its criticisms: as Inclusion London notes, the model can sometimes fail to explain or address the needs and experiences of specific groups of disabled people, but its approach to disability directly parallels the OT’s own holistic methods of implementing adaptation and inclusion within people’s lives and communities.

... the social mod el is a way to challen ge internal prejudi ces regarding disab ility

The Motability Scheme The Motability Scheme currently provides over 600,000 disabled people and their families with affordable, convenient, worry-free motoring, enabling them to exchange their mobility allowance to lease a new car, powered wheelchair or scooter.

Who can apply? The Motability Scheme is available to anyone who receives one of the following allowances, and has at least 12 months’ award length remaining when they apply: Higher Rate Mobility Component of Disability Living Allowance Enhanced Rate Mobility Component of Personal Independence Payment War Pensioners’ Mobility Supplement Armed Forces Independence Payment A parent or carer can apply on behalf of a child aged three or older and non-drivers can still apply, nominating up to three people to drive for them.

How does it work? Customers simply exchange their mobility allowance to lease a suitable vehicle which includes insurance, tyre and windscreen repair or replacement, servicing and maintenance, breakdown cover and road tax. Customers can choose from a range of over 1,500 vehicles, from the major manufacturers. A similar Scheme is available for powered wheelchairs and scooters. Cars are supplied through a national network of almost 5,000 Motability Dealer Partners. There is also a network of accredited suppliers of powered wheelchairs and scooters.

Adaptations to cars For most Motability Scheme customers, a standard car or automatic is suitable for their needs, but around 10% need adaptations to enable them to drive safely, or travel

in comfort as a passenger. As part of the lease, a range of popular adaptations are available at no additional cost, such as push-pull hand controls and left-foot accelerators.

Providing additional financial help Motability is a national charity, which oversees the Motability Scheme and may be able to provide charitable grants to disabled people who are eligible to join the Scheme but are unable to afford the vehicle, adaptations or driving lessons they need.

Further information

To find out more about the Motability Scheme, visit motability.co.uk. To find information on the grants available from Motability, visit motability.org. uk/grants

Lifestyle magazine All Motability Scheme customers can receive a copy of the free quarterly magazine Lifestyle. The magazine contains a mix of news and articles from Motability and the Motability Scheme, as well as interesting content and articles across a range of topics. Lifestyle is also available to read online, visit motability.org.uk/about/lifestylemagazine. Lifestyle is published on behalf of Motability by Wonderly, part of Haymarket Media Group, Bridge House, 69 London Road, Twickenham, TW1 3SP.

REHAB SUPPORT FOLLOWING DISCHARGE Therapies on Thames provides vital support services for those being discharged from hospital who still require rehabilitation at home

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t is widely accepted that people - especially older people - recover quicker once they have been discharged from hospital and are back in the comfort of their own home, and this has been more paramount than ever during the current pandemic. How quickly they can be discharged will depend on a variety of things including mobility, support from family and friends, and after care therapy support requirements such as rehabilitation, physiotherapy and occupational therapy. On discharge, a patient will be provided with a shortterm reablement service by the NHS and social care, however this will often only last up to six weeks. This is where support organisations like Therapies on Thames can be most beneficial for everyone involved in terms of ongoing therapy support, and it is their aim to help the patient regain as much independence and remain safely living at home for as long as possible. Goals for post hospital treatment vary depending on the person’s individual needs and might include regaining confidence, learning to use new mobility aids properly, adapting or regaining the ability to perform activities of daily living, and improving muscle strength, balance and coordination. Peter Knight from Wokingham is just one example of someone who has benefited from this type of support as his daughter Ali explains: “After my father was diagnosed with spinal stenosis, he was treated with a course of spinal injections which were followed by an operation to relieve nerve pressure in his spine. It was hoped this would also cure his dropped foot which had resulted in several falls, but unfortunately this was not successful.”

month on domiciliary care bills due to the number of carers, but thanks to the amazing work of the therapy team this has now been reduced to £400 a month, which is a huge saving. They have also helped us with advice on different equipment and are always on hand if we have a query or are worried about anything with regards to my father. I cannot put into words what a difference a company like Therapies on Thames can make to a family in our situation. I dread to think how many families have resigned themselves to their loved one not regaining their independence or are struggling to pay huge monthly care bills and knowing companies such as Therapies on Thames exist offers great peace of mind to everyone.” From its head office in Wokingham, Therapies on Thames offers home visits and residential therapy services through a highly skilled team of occupational therapists and physiotherapists, as well as collaboratively working with NHS and social care staff to maximize the benefits for their patients. By working with one of its therapists, the patient can achieve and potentially exceed their original recovery goals and this in turn can help provide peace of mind to family members who may be concerned about their loved one.

After a particularly bad fall, Peter developed pneumonia and spent two months in hospital and on discharge the family were told he would make no progress with his mobility as he had no sitting or standing balance therefore physiotherapy was not an option. At this point, Peter was being hoisted and visited by two carers, four times a day and the prognosis was that he would be unable to get out of bed or move around independently. Ali then took it upon herself to see what help was available and after many hours of research she came across Wokingham based Therapies on Thames which is run by Raj Senniappan, an occupational therapy professional with over 17 years’ experience in health and social care. “Raj came to my father’s home to do an assessment and asked that all the family be present, which immediately impressed me. During the assessment, Raj got my father to do things we thought would never be possible, and after seeing this and hearing about the support he and his team could offer we took the decision to go ahead and three years later the difference in my father is truly amazing,” explained Ali. From being dependent on help with everything, Peter no longer uses a hoist, has progressed to a walking frame with the support of his physio or carer and can get on and off the stairlift himself, which means he can go to bed when he wants. “We all know how expensive it can be to source home care support after a stay in hospital if you are a selffunder. Initially, my parents were paying £3,500 per

Raj Senniappan

For more information on the full range of therapy services available from Therapies on Thames call 0118 907 6345, email contact@therapiesonthames.co.uk or visit therapiesonthames.co.uk.

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Sunken Trampolines are the experts in providing trampoline solutions for schools, care institutions and families across the UK.

For a free consultation and site survey please contact us and we would be more than happy to help. Contact: Joel: 07801 573278 / Angus: 07765 256537 sales@sunkentrampolines.co.uk / www.sunkentrampolines.co.uk

Paediatrics All the latest from the world of paediatrics

SECTION ut in the garden, the snowdrops and hyacinths are starting to pierce their way through the blanket of winter detritus. The blues, yellows and whites of spring are finally blooming into the world, leaving behind the coldness of winter. With spring comes new life, and we can only hope that it’s a sign of things to come with all of our lives as we’re given the roadmap to leaving the lockdown.

With spring comes Easter, and with Easter comes a great opportunity to do some messy baking under

the guise of a sensory game. We’ve come up with some fun spring sensory crafts that are as entertaining as they are easy, which you can read about on page 46.

Now that the weather’s warming up a little, it’s a great time to get out on your bike. Quest 88 has been working with child development centres and SEN schools for over 30 years to get people on their bikes read all about it on page 52. As ever, if there’s anything you’d like to see featured, please don’t hesitate to send us an email. You can get in touch at ros@2apublishing.co.uk.

Read on to find out more...

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Hop into Easter

Spring into the new season with some fun sensory play ideas that are as fun to make as they are to play with!

MARSHMALLOW FONDANT While fondant is the final boss of bakers the land over, marshmallow fondant is a completely different experience from the usual tasteless, plastic and texturally unpleasant cake covering. Also known as LMF - Liz Marek’s Marshmallow Fondant - for its creator, it has the feel of a kind of edible clay, and is a great alternative for children who are bored of playing with slime. It can easily be made into a multitude of different colours, glitters, and is a fab addition to play where textural and visual stimuli are required. Liz’s recipe, originally published on her website sugargeekshow.com, requires you to mix in a small amount of standard fondant, but if you don’t have any of that to hand, here’s how to make something very similar with only 3 ingredients, adapted from The Spruce Eats:

MARSHMALLOW FONDANT 500g icing sugar 200g mini marshmallows 2 tbsp water (Optional: food colouring, flavourings)

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Place all of your ingredients out, ready to be used. In a microwave safe bowl, heat the marshmallows on high for 1 minute, until they become puffy; stir them with a rubber spatula until they become smooth and are melted through. If they’re not completely melted, ding them in short bursts in the microwave until the mixture is smooth and lump-free. Sieve in the icing sugar and begin mixing it with a rubber spatula. When you can no longer easily move the spatula through the mix, lightly dust a surface with icing sugar, then transfer your fondant on to it and begin kneading in the same way you would bread. Continue until the mixture is smooth and no longer sticky. If you can’t get the stickiness to go away, add a little icing sugar at a time and incorporate it into the dough. At this point, you may want to flavour or colour your fondant. Cut the desired amount from your ball of fondant, and flatten it out into a round disc. Add the desired flavourings and colourings, and knead them into the dough. It’s advisable to wear gloves to prevent your hands from becoming dyed or smelly at this step. It’s also a good idea to invest in gel colours for this, as the liquid food dyes you see in supermarkets may affect the consistency of your fondant. From here, it’s safe to play with and eat! Alternatively, it can be wrapped in cling film and stored in an airtight container.

NEST CAKES Is it really spring if you’re not being tempted by nest cakes every time you walk through the supermarket or past the bakers? Not on our watch. These truly are the easiest cakes in the world to make, and they don’t break the bank. They offer a great sensory play experience with kids: the warm, goopy chocolate mixing with the crunchy cornflakes is a great way to engage in messy fun with the added bonus of having cakes to eat afterwards. You can also go down the route of using shredded wheat cereals instead of cornflakes, and get really involved in shaping the nest properly so that it looks like a proper bird’s nest - that’s the kind of attention to detail we’ve come to expect from OTs! The bellow recipe is adapted from the bastion of all online cookbooks, the BBC’s Good Food.

CHOCOLATE NEST CAKES 225g baker’s chocolate 2 tbsp golden syrup 50g butter 75g cornflakes/shredded wheat Chocolate mini eggs Start by lining a cupcake tin with 12 cupcake cases - this is just to make sure your nests are neat and don’t fall all over the place when they’re sitting out to set. In a microwave-safe container, melt the chocolate, golden syrup and butter in short bursts of around 30 seconds, stirring after each burst. Once the mixture is smooth, add in the cereal and mix well to ensure it is completely coated in the chocolate mixture. Scoop a bit of the mixture into each of the cupcake cases, then top with chocolate mini eggs to complete the nest look. Chill in the fridge for a minimum of one hour, then enjoy!

SENSORY EGGS Add an element of sensory fun to the classic Easter egg hunt by making your own fancy eggs that feature a whole host of different textures, sounds, and scents. Fillable eggs are cheap and readily available in craft shops like Hobbycraft, meaning you can make them to your exact specifications. Fill eggs with sand, metal balls, slime, glitter - the possibilities are endless! Soak cotton wool in essential oils like lavender, mint, and orange and hide them inside the eggs to provide a soothing smelly sensory experience for children who find them hidden around the home or garden. The outside of the eggs can be decorated with glitter glue, brightly coloured sanding sugar, pipe cleaners, fuzzy balls, and so much more. A point of warning - the eggs should be sealed as well as you can if there are small particles or something that could be eaten inside it. A small dab of glue on the inside wall of the egg before it’s sealed up should keep it shut tight, but supervising children while they play is always the safest and most sensible option to keep play fun.

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ADVANCED TECHNOLOGY TO KEEP YOU ON THE MOVE

THERA-Trainer EXERCISE BIKES ACTIVE / PASSIVE

WHY THERA-Trainer? Regular exercise at home is encouraged to help maintain and improve muscle tone, circulation and flexibility, decrease fluid retention and increase stamina levels - all vital for anyone with limited mobility.

CHOOSE THE RIGHT EXERCISE bike to suit both your need and budget from our range of THERA trainers.

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01908 564100 info@medicotech.co.uk www.medicotech.co.uk MEDICOTECH

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Product FOCUS Every issue we bring you the latest products from across the market to help you improve the lives of your younger clients

Kids

IN GROUND REBOUND THERAPY TRAMPOLINES

Sunken trampolines produce the only UK-made in ground Rebound Therapy trampoline. Designed for both indoor and outdoor use it can be made to a size that suits your client as well as be made in a range of colours. Visit their website to find out more and to discover the range of options available. sunkentrampolines.o.uk | 07765 256537

NIKE GO FLYEASE

These amazing new hands-free trainers are being released in March from Nike. The clever design allows wearers to simply put them on and take them off with a simple movement of their feet, completely negating the need for using their hands. A stylish and ideal solution for anyone who struggles to put shoes on independently. nike.com

DINOSAUR PLATE

This adorable dinosaur plate is designed to make mealtimes with little ones much more fun, and hopefully a little easier. The cute dino will amuse young minds and the suction pads on the bottom of the plate will firmly hold it in place reducing spills and mess at mealtimes. dinksbabydecor.com

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GLITTER LAMP

This mesmerising glitter lamp is the perfect addition for a younger client’s bedroom or a sensory room. As the light is switched on the glitter swirls around creating an amazing glow that reflects off the walls and creates a beautiful and calming ambience that you can’t help but gaze at. dunelm.com 5

KEVIN THE KOALA

This weighted toy is the ideal buddy for young people requiring sensory feedback. Kevin weighs 1.2kg and is the ideal size to carry around to be cuddled whenever he is needed. Soft, cute and cuddly, Kevin will bring his owner a sense of calm and will be a friend forever. calmingblankets.co.uk 6

NAME PUZZLE

A personalised name puzzle is a great toy for little ones to help them learn and have fun. This puzzle will help kids recognise letters, shapes and colours, and will help develop their fine motor skills as they use the pegs to place the letters in their positions. Beechwood Story on etsy.com

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HAND-PROPELLED TRIKE

Tomcat’s hand-propelled trike is unlike any other trike on the market. Ideal for children who have limited lower mobility as they can use their hands to propel the trike, it can also be fitted with a carer control system that allows the parent or carer to brake, steer and aid propulsion from behind.

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ANGLED WRITING SLOPE

Learning to write can be a daunting task for kids, especially if they have limited dexterity. This angled writing slope will provide a comfortable and solid platform to support a child who is learning to write and encourage the correct writing posture for them at home or in the classroom. completecareshop.co.uk 03330 160 000

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ON YOUR BIKE

For over three decades, Quest 88 has been on the road, visiting people’s homes, child development centres and SEN schools with the aim of opening up the world of cycling to as many children as possible. The difference that being able to cycle can make to the individual, their friends, relatives and anyone involved in caring for them, is undeniable and this is something Quest is very passionate about. Rob Henshaw, managing director of Quest 88, tells us about their latest project to get everyone out and about on their bikes.

t’s been an honour to make such a positive difference to people’s lives with assistive technology, including the tricycles we have been manufacturing and developing for over a quarter of a century. Time is often one of the biggest obstacles faced by people supplying equipment such as our range of bikes and assistive technology. Time with the customer, time to cover all the bases, time to discuss their condition and learn about them, time to see what works best. Take a home assessment for example, they mainly happen in a small window between when a child comes home from school and before the evening meal is set, which is 52

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realistically a two-hour window. Two hours in total: 10 minutes to unload the equipment, 10-20 mins of setting it up and getting it into the garden or house, and then an hour and 15 minutes to assess, size, fit, adapt and try the equipment, talk about it, adjust it further and then another try. As we do our thing, we are aware of the time pressures on the parents or carers as we invade their home life, aware of the tiredness of the child after school and how limited and often precious this time is. Another challenge we face can be a lack of space when visiting people at home. This is where the idea for a cycle hub came from, creating a venue that addressed these issues and allowed families to travel to it in their own time.

We created the Quest Hub, an adaptive cycle shop purposely designed to welcome individuals and families to the huge opportunities and experiences associated with inclusive and adaptive cycling. Situated just metres from Shrewsbury’s park, and with great motorway connectivity the hub provides us with the necessary space required to hold many more bikes and accessories than you could fit in three vans, let alone one. Visitors can bring along their OT, family or friends – whoever may be involved in their care and helping them in their search for a solution which will enable them to enjoy the world of cycling, regardless of their level of mobility and independence. With the park around the corner, there is acres of space for customers to really try out the different cycles we have in a relaxed, safe, outdoor environment, which is not always possible when we conduct home visits. Cake, juice and coffee is on us as part of their visit too!

away a wider view of the opportunities and possibilities ahead and realise they are not alone. A phrase we hear all too often is parents saying, that someone said “he will never be able to do this” or “she won’t be able to do that.” It’s sad to hear such stories, but it’s not our job to judge or to comment. It is, however, our privilege to show them amazing equipment which can make things possible. It’s one of the best jobs in the world and we love it.

Whilst some families cannot travel due to distance or for medical reasons, many families are happy to do so which is great. The main appeal is that it’s all on the family’s timetable, often on a weekend and often in conjunction with sightseeing, shopping and a stopover. Another aim of the hub is to offer families more dignity as we do not have to enter their homes, which many appreciate as there may be several siblings and parents all at home when we visit. If the child is tired after the journey then we can take a break at any time. If we need to make major adjustments then the family can go next door for coffee or for a walk in the park. Again, it’s all about dignity and a relaxed enjoyable experience. The fact that everyone is more relaxed often means the child, who may also have associated behavioural or learning needs, is also relaxed and not picking up on mum or dad’s stresses. This also means that any purchasing decision, whilst not necessary on the day, is better considered and families have time to process the information given to them. Over the last 30 years, we have had the pleasure of working with many charities and organisations who are focused on making life easier for parents of disabled children as well as the children themselves, often funding or part funding the purchase of equipment. These contacts are invaluable as they often enable new customers to access support. The time afforded everyone as they visit or work at the hub allows more time for stories of encouragement and enables us to share other resources and ideas. This is so important. To share hope and to show parents in particular, that there are opportunities out there. Too many parents of disabled children still feel isolated and sharing experiences is crucial to helping them see that the world is bigger than they thought. This might be as simple as signposting them to a charity or to an accessible event such as Superhero Tri. Events like these, both actual and virtual, are a great way of families connecting in a very positive way. We want every family, everyone who experiences the hub, to take away not just a specialist cycle and all the independence and promise it brings, but also to take

QUEST 88 The Quest team still travel and visit homes, centres and schools, but for anyone who wants to see and try more, they can visit the Quest Hub where they can try cycles, running frames and the new Gameframes for football. You can still get a virtual tour or remote demonstration of a trike or tandem by contacting Quest at cycling@quest88.com or by calling 01743 363512.

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THE ANCIENT ART OF HUMANE TREATMENTS

What was occupational therapy before it was occupational therapy? In 100 BCE, it existed in the form of humane medicine, performed by Asclepiades of Bithynia

t’s well known that occupational therapy took its roots from a wide assortment of places: the treatment of soldiers in the aftermath of World War 1 and 2, the arts and crafts movement of the late 19th and early 20th century, and the powerfully progressive work of Eleanor Clarke Slagle to create the National Society for the Promotion of Occupational Therapy in 1917. Occupational therapy has, in some capacity, always existed, but where treatments through drugs and surgery have been categorised and collated, what was occupational therapy has not. Rather, it may have been known as “holistic” or “humane” treatment. You may be surprised to learn that as early as c. 100 BCE, a kind of occupational therapy was being utilised by a Greek physician to treat patients in Rome. Asclepiades of Bithynia was one of the earliest adopters of occupational therapy, utilising his holistic approach to medicine during the Hellenistic period, a time where the so-called father of medicine, Hippocrates, had made his mark on the medical world by establishing humorism as the du jour system of medicine at the time: in humorism, it was believed that the four fluids of the body - blood, yellow bile, black bile, and phlegm - contributed to a person’s temperament and health. We know about Asclepiades of Bithynia in part thanks 54

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to Pliny the Elder, the noted author and naturalist who had something to say about almost everyone in Ancient Rome, but Pliny’s feelings on Asclepiades can’t be called wholly positive. In his celebrated book, The Natural History, Pliny calls Asclepiades “a professor of rhetoric,” - that is, the art of persuasion, considered a skill in ancient times - “who considered himself not sufficiently repaid by that pursuit, and whose readiness and sagacity rendered him better adapted for any other than forensic practice, suddenly turned his attention to the medical art.” Pliny notes that Asclepiades had never practiced medicine before deciding to take up the art, and considered him a bit of a fraud: he thought that Asclepiades’ methods of treating patients were nothing more than a method of extracting money out of their pockets, noting that he didn’t have patients undergo the standard procedures of bloodletting and forced vomiting to cure their ailments. The author thought that Asclepiades act of dismissing all the medical discourse that had been established before his jump into the field, did nothing more than emphasise his fraudulence, writing: “Having never practised medicine, and being totally unacquainted with the nature of remedies—a knowledge only to be acquired by personal examination

and actual experience—as a matter of course, he was obliged to renounce all previously-established theories, and to trust rather to his flowing periods and his wellstudied discourses, for gaining an influence upon the minds of his audience.” But that wasn’t why Asclepiades disregarded the medical knowledge of the ancient Romans and Greeks: he thought that it was incorrect, yes, but that’s because he sought to establish his own doctrine of medicine, influenced by the philosophy of Epicurean. In Asclepiades’ humble opinion, the four elements and humours didn’t have an adherence in medicine, rather, he thought humans were composed of μέρη molecules - that are made of ἄναρμοι ὄγκοι - atoms, and this exists in πόροι, a void space. It was his opinion that diseases were caused by those molecules being in the wrong place or form within the body, and thus decided that therapeutic methods were better for treating what ails a person. Pliny said that his creed noted that there are “five great principles of treatment for all diseases in common: diet, use or non-use of wine, frictions, exercise on foot, and exercise in a carriage or on horseback.” While as OTs you’re not regularly dishing out pinot grigio to patients in the hope that they’ll turn out fine when the bottle is finished, it speaks to Asclepiades’ belief in the

holistic approach to medicine. He would recommend his patients a healthy diet, physical therapy, light therapy, hydrotherapy and massage, and was always friendly in his support of his patients. He took their feelings and comfort into consideration when treating them - hence the wine - and was a great anecdote to the other physicians of his time, who were bleeding and purging their patients so much they were considered butchers. He said that patients should be treated “swiftly, harmlessly and pleasantly,” and was considered a pioneer in the humane treatment of patients living with mental illness, who he took out from confinement and treated with music therapy. He was also one of the first to suggest that disease in water may be caused by microbes - an idea revisited by Louis Pasteur and proven true in the 19th century! Little is remembered of Asclepiades of Bithynia in comparison to some of his peers. Born c124 BCE in Prusias-on-Sea, now part of modern Turkey, he died in 40 BCE. It was said that he made a wager with the goddess Fortuna that he would relinquish his character as a physician should he ever suffer from disease in his lifetime. After a good, long life with much given to the art of medicine, he died at last from an accident. If that isn’t an anecdote for the power of occupational therapy, then really - what is?

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TAKING CONTROL

Video games have been an essential aspect of maintaining community and socialisation during the lockdown, but where should OTs go to ensure their clients have the adaptations they need to be part of the community?

ver the course of the lockdown, many people have turned to video games as a lifeline, to provide us with entertainment, distraction, and an opportunity to communicate and have fun with our friends in a safe, social way. Over the internet, our children can have fun with their school friends in Fortnite, taking down bosses in Final Fantasy XIV, ruining friendships in Mario Kart 8 or getting together with a group to watch a pal play something over Twitch, video games and the culture that surrounds them have given us an opportunity to spend quality time with our favourite people when we can’t do so in person. As much as games bring us together, they have an issue with accessibility: not every game is accessible to every player - and that’s not just in the sense that they’re now around £60 a game. Blind or visually impaired players can enjoy fighting games using surround sound to help them pinpoint the exact location of their fighter and the movement they need to perform, but if a developer changes this to mono - sound that only comes from one channel and is not based on position - they can no longer enjoy the game they love. A person who lives with rheumatism or arthritis may struggle to play a game where they have to “mash” buttons or complete QTEs or quick time events. That doesn’t mean that it’s impossible for people with accessibility requirements to get into the wonderful, varied world of video games - far from it! There are controllers, programmes, and many more options for people who want to get into video games, for the first time, or maybe get back into them after an event which has changed their accessibility needs. As video games can offer people access to a community, and an opportunity to socialise for social participation, the intervention and assistance of an occupational therapist can provide clients who may want to dive into the deep waters of video games with everything they need to get involved. There’s no use in getting a game if you can’t play a game. Most modern consoles - PlayStations, Xboxes and Nintendo’s consoles - default to the user holding the controller in both of their hands, with the left hand being responsible for movement via the joysticks, and the right hand performing actions through the face buttons.

Some people may not find themselves able to use the controller as it has been designed, simply because it’s designed for non-disabled people with a specific range of movements. There is no “standard” adaptive controller for either the PlayStation 4/5 or the Nintendo Switch; Nintendo, in some respect, alleviates this by implementing motion controls, which require less fine motor control to operate - for example, many of Mario’s actions in Super Mario Odyssey can be performed via motion controls over button presses. However, the Xbox One, Series X/S and PC have an implicit advantage in the accessible controller market with their official Adaptive Controller. Produced by Microsoft, the controller will work with both their console and their computer operating system, so it can be used easily across both platforms. The adaptive controller is, functionally speaking, a standard Xbox controller that’s been blown up and blown out, featuring large buttons and lots of ports for add-ons, which allows it to be customised in any way that the player requires for their adaptations. For example, a pedal can be added for people who use their feet in a prehensile way, or a joystick.

...the Xbox One, Series X/S and PC have an implicit advantage in the accessible controller market with their official Adaptive Controller

If your client doesn’t use a Microsoft product, or they don’t feel the Adaptive Controller fits their needs, there are a few places that you can go for advice or help on how to make video games as accessible as possible for your client. One Switch is a UK-based adaptation service for game consoles and toys, and they offer advice on DIY solutions for adaptations. SpecialEffect is another UK charity who offer hardware loans, and have their own assessment teams who can help arrange adaptations for video game hardware. Additionally, Remap offer unique, custom-made equipment for disabled people to enable them to play video games, designed and created by their dedicated network of volunteers. Lepmis, who are based in Nottingham, also provide assessments, and offer a variety of adaptive controllers and switch access adaptors to work with the consoles. All of these charities and organisations can be contacted through their websites, so don’t worry if video games are a language you don’t understand; the staff who offer guidance through these organisations are absolute professionals and technological experts, so your understanding of your client’s needs will help effectively guide them into ensuring that you get exactly what your client requires. Depending on your - or your client’s - level of handiness, there are modifications available for many consoles (mostly retro ones and PCs) which enable compatibility with switches and digital controllers, including the iPac from Ultimarc. There are also incredible designers sprinkled around the internet who offer 3D printing plans - for free - which allow custom modification of controllers and consoles. The only (huge) downside to this is that you need a 3D printer, and they’re not exactly a common occurrence.

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Medpage Limited to the rescue During the COVID-19 Pandemic Medpage has provided over 8000 items of Assistive Technology to Hospitals, Care Homes and vulnerable people living independently at home. An accomplishment we are very proud of. Despite difficulties faced by businesses caused by the Pandemic, Medpage has introduced new products to assist carers, professional and domestic. With trade shows and exhibitions cancelled for the year and the prospect of face to face demonstrations ruled out for the foreseeable future, keeping up to speed with new products is a challenge. We have added a section to our website containing detailed videos explaining the uses and features of our popular products. Head to our website and look in the Professionals menu.

Medpage Limited T/A Easylink UK

ive Be posit et We’ll g this h g throu together

Falls - Bed & Chair exit alarms Epilepsy seizure detection alarms Dementia memory prompting aids GPS location & mobile falls alerting trackers Remote monitoring via Wi-Fi & GSM

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National Helpline 0800 917 7650 www.alcoholics-anonymous.org.uk

Alcoholics Anonymous has over 4,440 groups throughout Great Britain dedicated to helping those with a serious alcohol problem learn how to stay sober. Groups are made up of people from all walks of life and all age groups. Through friendship and mutual support, members assist each other in coping which is made easier by meeting others with the same problem. There are no dues or fees for membership and anonymity is carefully preserved. Anyone who believes they have a drink problem can contact Alcoholics Anonymous by using the helpline number above or email; help@aamail.org Further information may be obtained from the web-site above or from the General Service Office at the address below. For information: P.O. Box 1, 10 Toft Green, York. YO1 7NJ Tel: 01904 644 026

SAFE CLIMBING The joy of being taken up to bed by mum is now a daily reality for four-year-old Cecilia Cann, thanks to an adaptable piece of technology from AAT

he kit is an S-Max stairclimber from AAT GB, fitted and accessorised with a booster seat and figure eight support harness. As a result, mum Lauren is now able to take her rather tall daughter Cecilia, who has cerebral palsy, low muscle tone and other physical impairments, up and down the stairs easily. The family, from Lincoln, live in a two-bedroomed house; Lauren’s partner is a key worker, who travels across the country during the week. This means that Cecilia would have to be taken downstairs before he left, which could often be at 5am, or she would have to sleep downstairs if he was away overnight. Lauren, who has back problems, also has a one-year-old son, and she was trying to balance the needs of both dependent children primarily on her own. The design of the house meant adaptations with a stairlift or through-floor lift was not possible. Through the local social services team, AAT’s regional manager Adrian Widger visited the family with appropriate PPE measures, and was able to tailor the S-Max with appropriate accessories to perfectly and safely support Cecilia, and train Lauren in its use. AAT’s S-Max stairclimber is in essence a slimline wheelchair with battery powerpack, that smoothly and safely propels the passenger up and down stairs using advanced kinematics, with minimal effort from the operator. A single charge of the batteries executes up to 300 steps up even narrow or turning flights, and over all common floor surfaces. When not in use, the S-Max can be folded compactly away. As Cecilia grows, the booster seat can be removed and the harnessing adjusted to ensure it continues to support her safely as she grows, thereby giving a cost-efficient solution. When no longer needed by Cecilia, the stairclimber can be taken into equipment stores stock and re-issued with appropriate assessment and training of the future prospective users. “Life has been difficult, I don’t have the capability to carry Cecilia on my own, it’s not safe for either of us. Cecilia desperately wanted me to take her up to bed, and would cry because I couldn’t,” says Lauren. “Now I can do it,

she’s so happy that mummy is taking her to bed. She loves it and asks ‘more’ as soon as we get to the top of the stairs! “The stairclimber has transformed our daily life, particularly with being confined to the house with COVID.” AAT is the only national provider of stairclimbers and support equipment. Its nationwide team of specialists can work alongside occupational therapists to assess free of charge, and with appropriate health and safety measures, the suitability of a stairclimber for the property, the client, and their carer(s). AAT can manage the whole process, from specification of any additional accessories if needed, supply of the equipment, and training of the carer who will operate the climber, ensuring a correct and safe solution. To book your free, no obligation assessment visit aatgb. com/booking-form.

THE IMPACT OF LONELINESS ON NUTRITION Dietitian Emily Stuart explores the effects that isolation can have on an individual’s diet and eating habits

hen it comes to loneliness, we are typically more familiar with the psychological impacts it can have on our health, as opposed to its physical effects. Research indicates that prolonged periods of isolation can in fact increase the likelihood of mortality by 26%, with bereavement or the loss of a loved one, key factors contributing to the problem. Since the outbreak of coronavirus last year, many of us have become increasingly isolated. The older population, especially, has been severely impacted as many have been forced to shield or remain indoors for fear of contracting the virus outside their homes. One common health consequence of this kind of isolation is malnutrition. Without help from friends and family 60

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older people may feel lonely, which can lead to reduced access to shopping and food, a decrease in motivation to eat regular, nutritious meals, and fewer social cues to eat, which can all lead to a reduction in quantity of food eaten. This inability to physically leave the house may also mean less food is consumed as shopping occurs less frequently and food supplies may run low as a result. Over time, frequently not meeting ones needs for energy and key nutrients like protein, fats and vitamins and minerals, can lead to measurable negative effects on the body. The consequences of malnutrition are wide-reaching and include a higher susceptibility to infection or other illnesses, more visits to the GP or admissions to hospital,

prolonged wound healing and more risk of falls or poor mobility. Malnutrition can often lead to swallowing difficulties – also known as dysphagia. This is a condition which Softer Foods customer, Fred, had to endure after his wife, Dorothy, sadly passed away. The bereavement left him highly vulnerable and susceptible to viruses which affected his voice, his hearing and even his ability to swallow. He was advised by a speech and language therapist that the food he was taking was too dangerous to eat and there was a high risk of choking. Fred tried to take the matter into his own hands and began liquidising his food: “When I started to prepare my own meals, I’d have to have all the pots and pans out, as well as the liquidiser. It was a huge inconvenience.” In addition, he was standing for longer periods of time, which was sore on his legs, giving him back trouble. After he was recommended Softer Foods ready meals it meant he was able to enjoy his meals again, as they were the correct consistency to help him manage his condition, so eliminated any risk of choking: “Beef stew and salmon supreme are some of my favourites. It’s lovely to have salmon without any bones in.” Fred values his independence and moving into assisted living is simply not an option for him: “I’m not going into a home. I’ve lived here with so many wonderful memories and now I’ve discovered this range of Softer Foods, it’s so much more convenient and means I don’t have to worry about what I’m eating. It’s hugely reassuring.”

In a case like Fred’s, when someone is experiencing recurrent episodes of illness, the risk of developing dysphagia can increase. Fear around choking or aspirating can be extremely limiting for someone living with this condition and can further heighten the risk of malnutrition and reduced appetite, in addition to the impact that illness can have. Each can also be a consequence of the other; 51% of those with dysphagia are at risk of malnutrition. Having access to meals of the correct texture with enhanced nutrition, whilst also appealing visually, can help to manage these challenging conditions. There is the additional convenience of accessing these meals through a delivery service, which will reassure occupational therapists with housebound patients, as well as supporting with their nutritional needs and further addressing the risk of malnutrition. Meals which are energy dense and at least 20g in protein, such as the Mini Meals Extra range from Wiltshire Farm Foods, have been designed to maximise nutritional intake for those with small appetites, ensuring that whilst the portion of food may look small, the appropriate amount of at least 500 calories is still contained within each meal. Wiltshire Farm Foods offers a range of texture modified meals, including its award-wining Purée Petite range, designed specifically for those living with malnutrition and dysphagia. For tips and advice on how best to address your patients’ needs and to view the full range, visit wff.link/otmag.

Research indicates that prolonged periods of isolation can in fact increase the likelihood of mortality by 26%, with bereavement or the loss of a loved one,

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The QuickWash Basin Meet the latest innovation from Ropox that is offering wheelchair users more independence and comfort in the bathroom

n amazing new wash basin has been developed to offer wheelchair users more independence, comfort and diginity. The QuickWash is the latest innovation from Ropox, and its’ unique design, developed by the Ropox research and development team, enables the basin to not only be height-adjustable but also to come forward from the wall, meaning the user does not have to bend or reach from their wheelchair, which can result in a negative effect on their posture. The first person in the world to benefit from the QuickWash basin is Mr Mann from South Wales. Mr Mann has always been determined to live as independently as possible without having to rely on care staff coming to help him with daily tasks, as his occupational therapist from Physical Adaptations explains: “As is often the case when working in a domestic property, Mr Mann’s toilet/wet room is a very confined space. One of his biggest issues was being unable to get close to the basin from his wheelchair which meant simple tasks such as washing his hands or shaving were leaving him increasingly frustrated and he would often have to change afterwards as his clothes had become so wet. Additionally, when positioning his wheelchair as close as possible to the basin, Mr Mann would often knock his feet against the boxing underneath the sink and this was becoming a concern as his condition means he has limited sensation in his feet.” Due to the lack of space available, the OT involved knew the choice of solutions was going to be limited, until she heard about Ropox’s latest product. The QuickWash

requires no electrics making it easy to install and when in the initial up position the 500mm wide basin’s projection off the wall is 530mm and 630mm when lowered. For wheelchair users such as Mr Mann, the basin can be lowered from its fixed point by 140mm and out from the wall by 100mm making it the ideal solution as they require additional leg room and have difficulty reaching a standard wall mounted basin. The intuitive design means that the lowering and raising motion requires very little effort as it is almost weightless, while the range of height adjustment available ensures the basin can be used by all the family, and at under £1,000 fully installed it offers excellent value for money. Mr Mann is delighted with his new basin as he can now access the taps and water easily once the basin is in position and the water now remains in the sink when washing or shaving as opposed to splashing out, meaning his clothes are still dry when he has finished. Mr Mann’s OT commented: “The basin has been truly life changing for Mr Mann and I am so grateful to Ropox for coming up with this latest product. He no longer has to bend or reach forward to use the sink which means his posture is always supported resulting in greater levels of comfort, while the independence it provides him with has reduced the need for additional support such as future care packages. Here in South Wales, properties with confined toilets and wet rooms such as Mr Mann’s is an issue we often come up against so it is fantastic to know there is now a basin solution which is cost effective, easy to install and will work in such settings to help our clients live as independently as possible. I would urge other OTs with clients in a similar situation to consider this great new product”. For more information on the QuickWash basin call 07444 577609, visit ropox.com or email ms@ropox.com.

David Wilson is a second year OT student at Coventry University and here he shares his experience of learning over the last year

ommencing a three-year BSc degree in September 2019 was an exciting new chapter. As a mature student experiencing lecture halls, and getting back into the classroom after 12 years working full-time was quite a culture shock. Yet the benefits of the experience of full-time work and the responsibility of being a dad allowed me to manage my time, and embrace the learning, self-directed study and working to deadlines. Then in March 2020, the campus-based teaching was interrupted and the remaining few weeks of our second semester teaching was moved online. I suddenly became much more familiar with MS Teams, and was also introduced to Zoom. The tutor’s response to this swift change of teaching method was admirable and our study continued on as best as it could given the situation. Among the many disappointments 2020 brought, the fact that our first practice placement had to be rescheduled was one of the biggest. It was understandable why this needed to be done, yet this left my year group missing what would have been the finale to our first year of studies. As the months continued through the first lockdown, our future plan for modules and the missed placement was adjusted to allow completion of the mandatory 1000 hours of placement experience, whilst still meeting the requirements for modules, and assessments. We began our second year in September 2020 now with the benefit of having an improved understanding of the virus and a brand-new digital teaching and learning platform. The university had adapted and Coventry campus remained open throughout, operating in a new fashion in-line with government guidelines. The university group was openly committed to delivering as much face-to-face teaching and offer the widest university experience as possible from September 2020. The blended learning approach manifested through five hours of campus-based time for each student for faceto-face practical and applied learning. Digital teaching and learning were facilitated through asynchronous online lecture content, synchronous online seminars, tutorials and workshops. One-way corridors and staircases, desks now spaced out with clear screens on wheels, strategically positioned to allow us to talk to each other without masks. The term ‘blended learning’

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...desks now spaced out with clear screens on wheels, strategically positioned to allow us to talk to each other without masks

was now the phrase, and considering our experience of university twelve months prior, this was almost another world with a different set of cultural rules. My morning commute was slightly shorter now as I simply needed to walk from the kettle to my study to attend most of my classes. As already said, lectures were delivered online as shorter pre-recorded introductions to core content, with more of a focus on learning through interaction and application. We were told that the university had agreed early on not to attempt the live streaming of lectures to the student cohorts, as it would only take for the lecturer’s wifi to cut out, and suddenly an entire year group may miss some of their planned teaching. Plus, wifi and accessibility issues from our end would have potentially impacted engagement with content. Engaging with the learning material through online seminars was a new experience. At first it did not always feel as though online seminars were the best format for exploring the module content, and in the early days we needed time to get used to the new behaviour within online classrooms. Issues such as the slight delay of the internet made it harder to interject during a group discussion. Or the regular faux pas of speaking, but forgetting you were on mute. However, despite this the online technology available, used creatively, allowed us to explore the module themes, and consider the wonderful and complex world of occupational therapy. Studying partly online and partly socially distanced on campus didn’t appear to stunt our togetherness as a class. In fact, engaging remotely with fellow students, while each comfortable at home perhaps enabled quieter individuals to get more involved than they perhaps would have in a traditional classroom setting. Our future career is all about adaptation and I think the staff and students rose to the challenge admirably and continue to as we progress through uncertain times. One aspect of my studies which I have found has improved significantly due to moving online is within

our university’s Occupational Therapy Society. I became the president of the society in September 2020, having served as VP the year prior. We worked with the Student’s Union to explore safe working options, and it was clear that a completely online presence was the only way to proceed. During the pre-pandemic year, we had invited some guest speakers to attend campus, however we found attendee numbers quite disappointing. We were asking students to return to campus during their free time, and especially in the darker winter months, this was a less desirable expectation. However, moving the society online allowed for some of the barriers with online learning, to serve as actual benefits in gaining student engagement. It was now easier than ever for students to participate in the society remotely. It was safe to ‘dip your toe in the water’ and see what it was all about, without having to venture physically into a room, and show your face. This new method of working also allowed us to reach out to OTs anywhere in the country, and indeed the world. Without travel and accommodation factors, professionals could remotely talk about their career, give presentations on their work, and answer student questions without leaving home. We saw our numbers rise sharply, and we continue to have fantastic engagement from both students and professionals alike. I am so proud of the team, the support we received from students and staff, and the fact it shows how making the necessary adaptations, changes the narrative from potentially needing to discontinue something, to instead enabling it to thrive. You can follow David on Twitter @DWilsonOT, and you can keep up to date with the Coventry Uni OT Society on Twitter @Cov_OTsociety and Instagram @covotsociety.

This new method of working also allowed us to reach out to OTs anywhere in the country, and indeed the world

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