Exploring the Art of Occupation

 A dictionary definition of the word independent shows it has many meanings, including ‘not influenced or controlled by others in matters of opinion, conduct, etc.; thinking or acting for oneself.’  ‘Not dependent; not depending or contingent upon something else for existence, operation, etc.’ Not relying on another or others for aid or support, and in Politics. a person who votes for candidates, measures, etc., in accordance with his or her own judgment and without regard to the endorsement of, or the positions taken by, any party.’

http://www.dictionary.com/browse/independent

But in the world of occupational therapy what does independent mean, to the therapist and to the person they are providing a service for?  This is something I have been thinking a lot about as I recover from a broken leg.

This recovery has been complicated by my existing disability, a right hemiplegia from cerebral palsy after a lack of oxygen to the brain during my birth.  The last three months have been some of the toughest of my life so far, and it’s all been down to my ability to come to terms with the lack of independence.

The issues of independence first began to play on my mind, after sadly a poor experience of occupational therapy whist in hospital.  I don’t think it would be appropriate for me to go in to this is to detail, but I will say I was concerned with their interpretation of independence.

After my operation I was having difficulty standing and began to transfer using a banana board, however my right leg was stiff and heavy with the extra weight of the pot, I could not transfer without someone holding it.

This was observed by one of the four OT’s I saw over the 16 days I was in hospital.  On discharge I ran in to difficulty and rang the OT to come out to do a home visit to reassess to my needs.  We disagreed on the help and assistance I required.

This mainly focused on the OT’s opinion I had independently transferred from the hospital bed to a chair.  I pointed out that the OT had held my leg during this transfer.  For me this was not an independent transfer. I must stress this is just my opinion and how the treatment I received felt.  But the OT service saw a broken leg and not the added complication for the hemiplegia and bariatric needs.

Discharge was not planned on admission, and unfortunately, in my opinion discharge from hospital was delayed due to the lack for forward planning by the OT team.  At this stage I cut ties with the OT service and sourced my own equipment paying for it myself, getting it in a timely manner with the help of some friends and family.

Interestingly enough whist in hospital. I was asked by the OTalk team to become a full team member. The first twitter chat I supported was ironic.  It explored if OTs within acute hospitals assessed and treated the mental health needs of their clients.  This again in my opinion was an area not addressed by any profession during my admission. #Otalk Blog

The affect of the broken leg on my mental health has been the most difficult part, those who are familiar with hemiplegia will also know that it is not just a physical disability and some of the symptoms include feeling depressed, heightened emotional sensitivity with inability to handle stressful situations.

Whist in hospital I found it incredibly difficult to manage my emotions, this was possibly made harder by the fact I was in over Christmas and New Year.  Social media, the tool I love became a focus of paranoia.  I made some mistakes in taking this out on people I love, something I am still dealing with the repercussions of 3 months on.  I was tearful on a daily basis’s and of course bored beyond belief. Friends and family did their best to visit and entertain me, during this time.  I am an extremely lucky person to have people in my life that have managed the moods, the tears and the frustrations.

Admitting and asking for help can be a hard, as a person with a disability you spend your life fighting systems and working hard to achieve despite the obstacles.  This might be some little victories like having a trampoline party as child because you were not invited to one earlier in the year as that’s child’s parents did not think you would be able to use the trampoline.  Or the large things like finish a degree, despite being turned down for your first placement because the educators had preconceptions about your physical abilities.

Some readers maybe thinking, I thought this blog was about independence, so sorry if I have gone off topic slightly, but I wanted to set the scene.

Those that have studied or have read about independence within OT will understand about codependence.  You might question is anyone truly independent? We all rely on others for something.  I found myself asking questions like, If I can use the toilet without assistance but need to be wheeled to or use a walking frame to get to the toilet is this independent??

Where does choice come in to this? can you or should you chose which parts of your life you want to be independent.  One example I have for this is prior to the fall, I would only wear flat slip on shoes without socks, as I find manipulating my hemi foot in to socks and shoes difficult.  However, after the operation my foot and leg have been very swollen. I’ve brought a wide fitting pair of shoes but due to the type of shoe I need to wear socks with them.

My first visit to the hospital physiotherapist, (10 days after having the pot removed) we had a discussion about putting my shoes and socks on, her priority for me to do this myself, however putting on this type of shoe is not something I would not normally do, although its something I know I need to work on it was not my priority at that time.

Over the past 3 months my independence abilities have changed on a daily basis some days I was more independent than others.  The equipment I’ve needed to assist me has changed dramatically from my initial thinking.

Facing getting out and about was one of the biggest challenges, for both myself and my family.  I became dependent on them when ever I wanted to leave the house, and a trip out needed to be planned in detail, much like a new mother with a new born baby.  I found I needed to plan longer rest periods than I did before the fall.

Tools like social media and the internet have helped with this I found I liked to look up where we have planed to go in detail, I look at pictures to help me understand the access issues and the distance I might need to walk, the anxiety of the unknown began to consume me.  My current challenge is to begin to go out without the safety net of the family, although I still require assistance to get my walking frame or wheelchair out of the car, I’m beginning by meeting a friend for lunch.

So I’m independently planning trips out with the toosl available to me, however I still require someone to accompany me, is this independent?

To help me explore independence in the future I’m planning on hosting a #Otalk on the subject on April 12^th at 8pm I hope to see you online then.

 Rachel @OT_rach