Driving and Community Mobility

Key Takeaway Points: 
- There are only 6 people in the state of TN who work with older adults & driving - these individuals who are being evaluated are just as dangerous as a drunk driver or someone who texts while driving.
- Being able to assess your patient just by looking at them is an extremely important aspect of being a licensed therapist and trying to determine what you think would be functionally challenging for these individuals. Be upfront with the patient about their driving capabilities based off of their assessments and the laws/regulations in the state in order to take yourself out of the equation totally to build patient rapport.
- First impressions (smile, shake the client's hand, make an effort to connect with the client, etc.) make a huge difference in therapist/patient care. It's important to be aware how you present information to your clients, especially when telling patients who have been driving for 40+ years that they can no longer drive anymore. This is a huge deal for them and as an OT, you should be upfront and honest with the patient while still remaining empathetic and caring towards the patient.
- Three purposes to performing driving evaluations:
1. Assess individuals for safety and potential to drive (stroke, person with autism, patient with SCI)
2. Evaluate people with physical disabilities for appropriate adaptive equipment (how will they get in/out of vehicle safely?)
3. Train individuals in the use of adaptive equipment and/or compensation techniques for driving

Common Diagnoses Served:
- CVA
- TBI
- SCI
- Amputations
- Alzheimer's Disease (#1 diagnosis Cody sees/evaluates)
- Muscular Dystrophy
- Cerebral Palsy
- Impairments in visual processing
- Intellectual disabilities

•  It's important to know diagnoses and understand their characteristics to determine whether or not it's safe for individuals to drive

The driving evaluation has 2 components:
1. Clinical eval
2. Behind the wheel assessment

OT Interventions: 
1. Individual - Having the client turn their neck and torso to locate road signs placed at various locations around the room and having them make driving-related decisions (checking rearview mirror, braking, steering, etc.)
2. Group/Population - Work on response and reaction time by having members of the group stand in a circle and keep a balloon in the air. As the game progresses, add more balloons to increase response and reaction time.

Reference: American Journal of Occupational Therapy, November/December 2014, Vol. 68, 662-669. doi:10.5014/ajot.2014.011247

Nutrition and Aging

It's common knowledge that nutrition is crucial in an individual's physical health, mental health, and overall quality of life. Without proper nutrition, our bodies are unable to work effectively and provide us with the fuel needed to energize our daily activities. Nutrition in older adults is often overlooked, especially in a facility such as a hospital or a SNF. Often those older adults who are in these types of settings have a more crucial need for proper nutrition because their bodies enter a stressed state which requires significantly more calories to be consumed since the patients' metabolism is working harder than it's used to. The key takeaways I made from this lecture was that proper nutrition early on, especially in settings such as acute care, is vital to a patient's recovery. Proper nutrition is just as important as the medications they are receiving and should be a top priority in patient education. Another takeaway was the reminder that we as (future) OT's can address proper nutrition within our scope of practice. Knowing the importance of proper nutrition and how the body can become hypermetabolic in a distressed state is something we should be able to address with the patient in order to not prolong their length of stay.

OT Interventions:

1. Individual Intervention - An intervention with an individual could be to educate them on the importance of proper nutrition and assist them, and/or their caregivers in keeping a food journal. By being able to write down what you eat, it allows the individual to be aware of and see how little food they are consuming each day. 
2. Group Intervention - A group OT intervention could include a group cooking class with a folder for the clients to take home of proper nutrition handouts, simple healthy recipes, and meal prep tips. This gives the group an opportunity to receive verbal education, experience cooking or prepping healthy food, and ask questions while also taking home handouts to increase the carryover to improve their nutrition habits. 

Effective Vs. Poor Communication

Communicating is one of the first skills we were taught as small children. This is how we are able to transmit our thoughts and feelings to others. It seems like such a simple concept, yet ironically it is something we as humans find as one of the most difficult elements of our daily lives. So many different details go into effective communication, not just speaking and understanding. Everything must work together like a well-oiled machine in order to be effective. Body language, facial expressions, posture, voice, and tone of volume are just a few key aspects of communication. As a future OT, there are many different people I will have to communicate with on a day to day basis: Children, parents, my supervisor, my co-workers, caregivers, my spouse, older adults, nurses, and the list could go on and on. The benefits of having good communication skills with my future clients are to establish a trust between myself and my patient to allow them to disclose information they may feel uncomfortable with, provide a greater patient satisfaction, and connect with the patient in a way that makes them become more motivated and allow them to see that I care about them as a person and their progress. Poor communication with my clients could lead to a decrease in patient confidence and trust with their therapist causing them to not share information relevant to their health and well-being, discouragement and feeling of unimportance of themselves, negligence, and patient complaints. Ultimately, communication is the key to a healthy relationship between you and your client. By being cognizant of who you’re communicating with and appropriately responding in a way that is positive and engaging, you will become a successful communicator.

Reference: 
Davis, L., & Rosee, M. (2015). Occupational therapy student to clinician: Making the transition. Thorofare, NJ: SLACK Incorporated.