Occupational Therapy at Minds Matter
By: Erin Burgert, OTR/L
Why I love providing this service.
When asked why I love being an Occupational Therapist (OT) I respond, “I get to help people find amazing ways to do the things they want to do.” When asked why I love working for Minds Matter I respond, “I REALLY get to help people find amazing ways to do the things they want to do.” It has been an amazing journey. I get to work along-side individuals that have challenges to overcome and be afforded the time to truly understand their needs and the barriers. We are given the opportunity to fail, try again, fail again, try some more and…..SUCCEED!
When I first met Steve, his goals were to be able to use the computer and to increase his socializations. With the help of his previous OT, he was taking the bus downtown to the library to use the computer. He often did not recognize where his stop was and would remain on the bus or couldn’t navigate his way back to the bus stop. After learning more about Steve, we realized that more importantly than going to the library, what he really wanted was to travel. He wanted his world broadened. So, we added a goal, “Steve will ride the bus downtown and return home safely.”
Physically, Steve gets around pretty well. His memory, on the other hand, is not great. Even more significant, his awareness of his “not great” memory is “not great”. When walking around downtown he appeared to passively walk through his environment, not actively creating any connections. My task as his OT was to help him make some connections. We tried everything. We tried instructions; fail. We tried pictures but Steve would not remember to look at the pictures; Fail. We tried verbal mnemonics; fail. We tried topographical indicators; not a fail. Slowly but surely Steve was able to “look for the tower” to help guide him to the bus stop. However, this was not 100% accurate. We needed a safety net. I started using the map on my phone paired with the topographical indicators. Eureka! This seemed to work! I was able to replace my voice and cues with Siri’s automated verbal cues. After much trial and error with map programs and phone types, Steve’s speech therapist was able to secure reimbursement of a phone for Steve through the Telecommunications Access Program (TAP).
However, securing a phone opened a new set of needs and barriers. The primary issue? Steve didn’t actually know how to use a cell phone. We started with the basics. Understanding how to use a stylus on a touch screen (while identifying the right phone for Steve it was determined that finger pressure was not an option, he needed a stylus), placing a phone call (his initial trials were clocked at fourteen minutes to go from engaging phone to hitting “call”) and understanding what those icon pictures meant. We got the whole team involved. Steve worked on using that phone with every team member that walked through his door. He was given homework and asked to call me frequently and say silly things that I programed into his phone until he and that phone were compatible. Then we began working on using his preferred map app. We practiced, practiced, practiced until using that map app became as routine to Steve as watching TV.
Our next big step was to begin pairing the phone with the locations of interest downtown. Steve and I programed points into his “favorites” and named them, and re-named them until Steve was able to recognize the cue. Then we practiced. We walked the streets of downtown Lawrence over and over again then again for good measure. Slowly, I started backing off. I began following the bus Steve was on downtown, ready to meet him when he got off. Then, I met him downtown, remaining just out of sight so that I could observe Steve and chase him down when he missed a turn (which he did frequently at first). Then we started meeting at a coffee shop and eventually other locations. Steve’s confidence gained with every trip! I knew Steve had really met this goal the day I got a concerned email from his Cognitive Therapist (CT). Steve had missed their session because he decided instead to head downtown!
Although that initial course of action took us over a year to solidify, Steve has since learned two new routes with transfer points. Each time we take on a new route he is able build on those basic skills that we worked so hard to turn into routines. With each route we have had to tweak techniques and problem solve new patterns, but Steve has shown an amazing ability to take ownership of the task and grow exponentially in his confidence. Another signal to me that Steve really grasps this concept and is meeting his goals was when I got the phone call just one month ago. Steve had missed his bus headed home from his favorite bistro. He called to tell me it was alright, he was taking a different bus from a previous route and it would be coming soon. In the process of establishing a sequential set of routines, Steve has found a way to connect these routines to make decisions of his own and still safely return home. THIS is why I love being an OT at Minds Matter.