Reflections

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

Ilove skiing and have skied for over 43 years with no major accidents. This year however, I fell awkwardly, which resulted in me having a lovely lift off the slopes in a helicopter and experiencing the Swiss emergency care service. On returning to the UK, I was diagnosed with a ruptured anterior cruciate ligament and twisted meniscus. Surgery followed to repair both, and I spent six weeks in a fulllength brace, non-weight bearing for the first three weeks and partial weight bearing for the next three weeks. The time I spent in the brace was a real learning experience and I wanted to share three things which have really impacted me as a therapist.

REFLECTIONS

MENTAL HEALTH

Any surgery leaves you drained as your body is getting over the trauma and the anaesthetic. I had not, however, appreciated the level of fatigue you have from managing your day-to-day life with your leg in a fixed straight position. Everything - and I do mean everything - is impacted: using the toilet (radiators and sinks are very handy ‘rails’ even though I knew I should not use them), getting up and over the shower threshold, preparing a drink or a snack and if achieved, having to stand there to eat or drink as I could not carry anything. The challenge of doing everyday tasks was exhausting; everything needed to be planned, there was no nipping up the stairs for something I had forgotten or popping out on a visit. Luckily, I was able to problem-solve my own solutions, order equipment that would help, and arrange for a driver. However, the level of fatigue was enormous, and I found myself planning less and less, spending more time at home as it was just easier. This resulted in less social contact, causing my mental health to really feel the impact, and I found as my mood deteriorated it made me want to do even less. The reflection for me as a therapist has been that we need to work with our clients on fatigue management, and listen to them about what is really important to them, alongside how much they can do, and when they want to do it. Remembering that doing the things we really enjoy and love to do, has a massive effect on our mental wellbeing. PHYSICAL ENVIRONMENT

We take for granted that we can walk out of our home, down the street and get on with our lives. This is not always possible if you are a wheelchair user, our built environment has not been designed to meet their needs. The simplest things become a barrier; the camber on a pavement requiring all your upper limb strength to keep you from ending up in the road; the lack of dropped kerbs which means you are pushing yourself for much longer distances to find an accessible route; the poorly maintained paving that you cannot get over; the dropped kerbs that fill up with water meaning your hands are permanently wet or muddy, and the limited circulation space in shops and cafes. The list could go on and on. The reflection here was that everything takes longer, it takes more thought and more planning having to think about every potential barrier before going out. This results in less spontaneous trips and socialising opportunities. As a therapist, I need to think more about making glib comments on telling clients what accessible activities they can do, for example, suggesting they go to the theatre, which is the end activity. The planning around this activity has to include the whole activity analysis from the moment you leave your home to the time you return. PUBLIC ATTITUDE

I was surprised by the attitude of the general public to a person in a wheelchair; I thought that we had moved forward in society’s perceptions and understanding of disability, but I was wrong. I was ignored, bumped into, and at times treated with contempt. How do we acknowledge this and work with our clients on how they manage other people’s behaviour or attitudes whilst maintaining their own wellbeing? As a society and as therapists we have so much more to learn about the impact, attitude, and design of our society, and as one of my clients said to me last year: “Stop being relentlessly positive, my situation is sh*t, Kate. Please acknowledge that and we can then move forward to making it a bit less sh*t.” This comment really resonates with me now, and I know that how I work with clients will change from this point onwards.