Hello everyone, and welcome to our first episode of Beyond Barriers, Navigating Health and Function.

I am your host, Pam Hung, an Occupational Therapist living in Edmonton, Alberta.

Over the next few episodes, we will be talking to Occupational Therapists in Alberta, Canada that work in different practice areas with clients of all ages and diverse health conditions.

We're going to be talking about the many ways Occupational Therapists promote engagement and participation in everyday life activities.

If you want to learn more about what Occupational Therapists do, you are in the right place.

Today we will be speaking with Megan Maiani, an Occupational Therapist and PhD student at the University of Calgary.

She has worked as an Occupational Therapist with adults that have neurological conditions such as stroke and brain injury for over 17 years in various clinical settings.

And she is now working towards her PhD in Neuroscience at the University of Calgary.

Today, we will dive into what brought her to this area of OT practice, how she has helped clients find creative solutions to challenges they encounter as they do their everyday life activities, and how occupational therapists have a unique role as part of the healthcare team.

Let's get started.

welcome, Megan.

Why don't we start by, having you tell us a little bit about your practice area and what drew you to work and now do research in this area.

Pam, for having me.

So I think I started working in neurology almost straight out of school.

I found it very challenging at first.

And then, so I worked in a few different areas, but I was drawn back to neurology.

I think one of the things that's really interesting about it is that everybody's brain is different and so no two brains are alike.

You're always seeing different challenges that people are having, and then being able to come up with really creative solutions to help them overcome those challenges.

So what sort of challenges in this area do people experience or what types of conditions might people have that you would work with in this area?

if somebody had a stroke, for example, It could affect any part of their functioning.

So they might have difficulty walking, talking, using their hands.

so that could mean that they have trouble getting ready in the morning, that they have trouble walking around the house, working, going to school, playing sports, playing with their kids, all of those sorts of daily activities.

as an occupational therapist, you really are focused most on what is the thing that they want to do that's important to them.

if the goal is I want to get on the floor so I can play with my children or my grandchildren, then we try and figure out why is that a challenge for you?

Is it because you have some weakness?

Is it because you have a hard time concentrating when there's loud noises?

Is it, because of your balance?

So we look at all sorts of different things.

and one of the areas where I worked a lot in, was vision.

So it's quite common after a stroke that somebody could have problems with vision, so not being able to see everything that's in their environment, but also perception.

So not being able to use that information in a useful way to tell them about their environment and give them the update on what's going on around them.

Okay.

Yeah, no, that's great.

And you've honed in on 1 kind of specific area that you're really interested in.

So, when we think about those kind of specific areas where those, People might have challenges with vision or with their perception.

What does that kind of look like in everyday life?

what are some of the things your clients maybe told you that they experienced,

Yeah, one of the things that can happen is what we call a visual field deficit.

So maybe part of their vision, they just don't see all of it.

So if you think of vision like a, like you're looking at a circle or a pie, maybe half or a quarter of that pie is missing.

And so When you don't see everything that's in your environment, you might trip over things, you might have a hard time finding things in the cupboard, you might have trouble finding things in a busy store, you might, walk into things on one side, and most of the time, too, you might not be able to drive anymore.

because that's a skill where you really need, or an activity where you really need good vision.

Yeah, and it sounds like pretty much any activity that someone does in their day, you talk about the grocery store, being able to find the right cereal that you like on the shelf or something like that.

Right or even reading and those sorts of things too, I imagine can be impacted.

Yeah.

I have an example of, a woman I was working with who she noticed different things about how she, like shoveling, for example.

So she finished shoveling her driveway and she noticed that there was still stripes of snow all over the driveway.

And then she realized that it was because it was on her blind side, so she thought she was catching all the snow on the shovel, but it just kept falling off of the side.

But she just kept going to the right, and then at the end she had this sort of stripy driveway that she had to go back and fix.

So for her that was an example of, oh, this is maybe I really am missing things on that side that I thought I was noticing.

as an occupational therapist, how do you help someone, when they're experiencing these challenges or what's the role of occupational therapy, for people that have challenges with vision?

We always want to start with finding out, what a person's life and routines and habits and activities are.

So we'll take that information.

how do they spend their time during the day?

Who are the people that are important to them?

And, and then we try and deduce what activities might be challenging for them just based on not having that full vision.

And then we get input from them about, What are they noticing is different and what are they feeling not confident at?

So part of it, the first part is always narrowing down what the goal is and what are the activities we want to work on.

And then another big part is teaching people what it means to have change in their vision and also just different strategies and things that they could be practicing or looking out for.

so we might, for example, help somebody rearrange their house so that they know where to look for things.

We might also teach someone.

different strategies so that they're always making sure that they've scanned far enough into their blind spot so that they can be confident that they've seen the entire page or the entire driveway or the entire movie screen or whatever it might be.

Yeah, so it sounds like quite a lot of education and practicing of different strategies to figure out what, what works for people.

What works for some people?

Exactly.

And everybody's different and, and everybody has different sort of motivations for, being in therapy and for practicing these skills.

naturally, some people, some people, if it's something like driving, it's very important to them.

And sometimes other people are like, it's okay, I trip sometimes, but it's not that bad.

So we take that into account too, because we really want to help people find what's important to them and make sure they can do those things that are important.

and then if it's not important to them, it's maybe it's not worth working on.

and it probably even depends on what sort of support systems people have around them, right?

I can think of, like, you know, if someone has a spouse that typically does all the driving anyways, right?

And maybe it's not, maybe that's not necessarily what their goal is at the time.

So being able to really individualize it is,

probably quite helpful.

Exactly.

Maybe they want to be back to their old level at Scrabble and want to make sure they're seeing all the tiles on the board.

that's excellent.

That would probably be one of my goals.

I quite like scrabble.

do you find that, People are able to recognize that they do have challenges with their vision and perception, maybe after they've had a stroke, or is it maybe others that might notice people having difficulty or maybe missing things?

is it quite common for others to notice before maybe that individual or client or what does that kind of look like typically?

That's a very good question because, when you have an injury to your brain, it might not just affect you.

So, maybe you do have a change in your thinking skills, or maybe you do have a change in, your self awareness or your insight.

And I would say that it happens both ways, where sometimes it might be the family member, the partner, the good friend who notices that something is off, before the person themselves notices the change.

like you say, it's probably quite individual, or maybe the individual notices some things, but then maybe someone else in their life might notice other things.

Exactly.

Yeah.

Yeah.

Excellent.

what other health care practitioners work in this area or who might who else might be on the health care team, to help someone that's, that, experiences a stroke or even just to address those more specific, visual challenges.

with, when we're treating people who've had, stroke specifically.

I would typically work with a physiotherapist.

We would collaborate on a lot of different areas.

um, in physio, they might be working on balance and strengthening and walking.

And then an OT's job is really to apply those new skills that have been gained to the everyday activities that.

someone wants to do.

So a physio might say, okay, let's get you walking forward.

Let's get you sidestepping.

And an OT might say, let's take you into the kitchen now and have you sidestepping along the counter.

Let's have you bending down to grab that pot or that bag of flour or whatever it might be.

we also often work with speech language pathologists.

So when someone has a stroke and they have difficulty speaking, communication is so important.

So we collaborate on that.

And then, if that person also has trouble with, Vision after their stroke, then I would often work with a speech pathologist.

Just we would overlap on some reading skills and strategies that would make life a little bit easier for our clients.

we collaborate a lot with, optometrists or ophthalmologists as well, because if someone has a.

very serious problem with their vision or, or their perception.

That would be something that we would want to get some more medical support with too.

Excellent.

Yeah.

And it sounds like you've kind of, there's a lot of rehab professionals involved, but then also other people in, the healthcare world as well, which is really wonderful.

and even just, you highlighted some areas where there is overlap between the professions and, whereas OT really looks at that really functional aspect.

we take what people are working with other professions sometimes and, translate it to everyday life or those everyday activities.

Exactly.

I think that we have a really integral role on the healthcare team because, are, we are applying all of those skills to the activities that are important to people.

and really as far as OT is concerned, you're not really finished or you're not really successful until we've found a way or exhausted all our options for you to do the things that are important to you.

so in what ways do you think that really contributes to, even health, well being, or how people even engage with healthcare providers,

I think that in this area, and I think in a lot of areas as well, the one thing that OTs are really good at is learning about their clients.

it really is my job to figure out, what somebody values, what they believe about.

their health condition, what they, if they have beliefs that they should be the care provider and they don't want to accept the help or, beliefs that they want to try, neuropathic therapies or beliefs that they only want to follow Western medicine.

So I think really what makes OTs different is that we take the time to learn those things about our clients.

And so when we are.

helping someone reach their goals.

We have all of these different factors in the back of our mind so that we can really understand them.

So we don't really give one stop shop, custom recipe types of therapies because everybody is so different and unique in their injury and their outlook on life.

Really the whole reason behind OT is that, everything we do and all the activities that are important to us, they give us meaning and purpose.

And when those activities are taken from you, that, that's life changing for people.

So we want to bring back some normalcy after, after some type of health condition.

And in my case, it just happened to be, a neurological injury that my clients had.

and that's where you have, found, your niche in that area, not only as an OT working in practice, but also, in doing some research as well.

So, um, it kind of leads me a little bit to the next question around what types of challenges have you faced as an OT working in this field?

I think that one of the things that has been challenging is that, I've worked as an OT for a long time.

I have tried different things with different people.

Sometimes I hit the mark and sometimes it's a complete miss So over the years you develop a little bit of, experience and, anecdotes about this usually works, so let's try this first.

And, I think one of the things that's challenging is about as an OT is I can talk to another OT who works with the same type of people that I do.

And we both know that this one treatment or this activity works for a lot of people, but there's nothing in the research that says.

That, that's what you should do.

So if you're a new graduate OT or you're new to your practice or you're practicing, you know, you've changed practice areas and, Where do you get that information?

Right?

So it's hard to just build that repertoire of experience because we don't really, OT is like working with people.

We don't love doing research as much.

So therefore we have less research that kind of helps tell our new graduates, and also tell our team members.

this is what OTs do and this is how they do it.

And we know for sure that it works.

so I struggled with that a little bit, which is, why I ended up going back to school was, to study children who have these visual problems and learn more about what's going on there and what we can do to help kids earlier.

it is interesting because, I think you highlighted such an important piece that we look at people as individuals with, their own value systems, their own, priorities.

And so sometimes that even makes it challenging to apply some of the research, that is out there to, to our work as well.

but yeah, and it's true.

And the fact that even, um, you know, OTs.

Our, our role is so focused on everyday life, but, what does that mean?

And how do you define that?

Because everyone defines it so differently.

So, um, yeah, I think those are all, like, really interesting, really interesting points to think about,

Yeah,

Is there anything that you wish other health care professionals knew about OT?

I think that sometimes we're seen as more of an art than a science, and I do believe that we're both.

I do think that we're, very, knowledgeable.

We are very, astute and we are up to date with best practices and we're always looking for the best ways to help our clients improve.

But one of the challenging things about that is that when we talk about our clients, we always talk about them In terms of, Oh, they made muffins this week and that was really important to them.

So it sounds very airy fairy, but really a lot of, there was a lot of knowledge and theory and, and experience and skill that went into helping them achieve that goal.

that's something that's so meaningful for people, right?

particularly if you think of someone that, maybe they made muffins every week for their grandchildren, right?

And it's hard to, it's hard to, put a number or, put value on that when it's something that's so important to someone else.

Exactly.

Are there some ways that you think that could help address some of the challenges that OTs might face, even just related to, how much evidence is available to inform practice or resources or anything like that for other healthcare providers or healthcare in general?

I think that we really need to take the opportunities wherever we can to, network with others to attend conferences, even attending, conferences and learning opportunities that aren't specific to OT, they can still be bits of knowledge that we can glean from that and then integrate into our practice.

I think that.

the better we can understand, somebody's condition and what's happened in their body or their brain, in my case, the better I can find ways to help them.

so I think that, as OTs, that biomedical knowledge is important, and then we add that OT flair of, relating it to activities.

And I think that letting other healthcare professionals know that we have both is important just in building the professional relationships and the credibility and, and the trust between professionals.

and even some of that informal networking that happens, outside of, say, the clinical setting or the work setting, talking about patients, how I think really helps.

people to even better understand occupational therapy in general and what it means for different populations.

when it's a little bit, maybe separate from the clinical work that we're doing on a day to day basis, right?

Yeah.

My Nona, I've been an OT for 17 years and my Nona has only just stopped asking me for massages.

Yeah.

Yeah,

I'm sure any other occupational therapist listening to this can probably relate to, um, you know, Introducing yourself as an occupational therapist and someone responding with, I'm retired.

I don't have a job, but we can do much more than just someone's employment position.

it's all about the occupations of everyday life.

So, um, yeah, when we think about, or if we're talking to other healthcare providers or practitioners, what are some things that they might, need to watch for, look for, if they are thinking about whether a person might need occupational therapy or where occupational therapy might be helpful for them.

I would say that if a health professional, if they notice that their client is improving on, different markers.

So they take them for a walking test and they're getting faster and they are reading more pages and, their blood glucose is better.

So all of these health metrics, but if those are improving and somebody's quality of life isn't, or they don't report an improvement in their quality of life, that's probably the time for them to stop.

When you would want to refer to an OT because we would be able to look more at, again, the daily habits, routines, values, all of the things that are meaningful to our client and just put the pieces together and help that person realize what the missing links are and how we can help them return to the quality of life that they want.

Yeah, and even, help them to find ways to, participate in some of the activities that maybe they really enjoyed before or were quite meaningful to them.

So, if someone was looking for support from an occupational therapist for maybe themselves, or a family member, or someone else they know, how might they find more information to learn about working with an occupational therapist?

I think that the big organization, so the Canadian Association of OT is one resource.

They have a website that can explain what occupational therapy is and what an occupational therapist does.

And then you can also look at like the province of Alberta.

There's a few occupational therapy organizations, and they also help clarify what some of the rules of OT are.

But also, we're, we are a chatty people.

So you can also just call one of us and say, you know, this is what's happened.

I'm having trouble with X, Y, Z.

Do you think an OT would be able to help?

And anybody that you know that works in OT would probably be able to answer that question.

Yeah.

Thank you, Megan.

Um, yeah.

And I mean, of course there is like other information that people can find online from, um, this organization, the Society of Alberta Occupational Therapists.

Can you share an example?

I know we've talked about lots of different ways OT, supports people with visual or perceptual deficits, or if they've maybe had a stroke, can you share an example of a client that maybe you worked with, and how your involvement in their care, changed how they were able to engage in some of their daily activities

so one of the things that somebody might have trouble with is busy environments, and I had a client I was working with, for example, who got very overwhelmed.

In large stores.

So your Walmarts, your Costco's, even the grocery store.

And one of the things that she had trouble with was.

finding items on the shelves, and also reading the prices.

So sometimes she wouldn't scan or look at the price correctly and then she would take it to the cashier and think, this isn't a deal, I thought I was getting a really good discount.

And so we worked on strategies to, to improve her scanning skills.

We practiced some scanning.

We slowly introduced more and more difficult visual environments to her.

So that her brain got used to parsing out information and being able to pick out the important bits of information.

And then this also ended up helping her ride the bus better.

She, would often take the wrong bus because she wouldn't be seeing the name on the bus accurately, or she would misinterpret the number on the bus and she might get on the wrong bus and then end up downtown and she didn't want to be downtown.

And working on these skills.

really helped with just her independence in the community, being able to get out of her house and go to the places that she needed to on her own, to be in busy places with lots of other people and not feel anxious or overwhelmed.

and then even translated to just making life a little bit easier at home and using some of the strategies to organize her home differently.

So that she just was a little more aware of her environment and caused less frustration for her.

what a great example of how some of those skills that when you start with one challenge that someone's having, you know, learning some of those skills and strategies really transfer to do, other activities in someone's daily life to help, support them to be able to do all the things they need or want to do in a day too.

That's wonderful.

Mm

Okay, so I've got one, just one last question to, to wrap up here today.

what qualities or skills do you think are important for occupational therapists to have, or maybe important skills for someone who wants to be an OT to either, work on or acquire or even just have?

hmm.

Mm hmm.

Yeah, I think that, I've always thought that the most important skill for an OT is that active listening and the empathy.

So really being able to see, and, and try and empathize with somebody's experience and set aside what your own preferences, values are, and focus on what it is that your client really wants and needs.

So for example, I, I do not, Ride a motorcycle, if I have a client that that's really important to them and they want to work on their hands so that they can, Rev the throttle and get back on the bike, who am I to say I, you know, So it's my responsibility to learn how to do that and how to help them because I know that's important to them and I So just being able to meet people where they're at, listen to what they tell you.

And sometimes people, it's a bit reading between the lines and trying to understand them as a person so that you can really offer them the best help.

Yeah, those skills that really, relate to connecting with other people are so important.

Yeah,

for

exactly.

I think that's really what makes a strong occupational therapist.

That's great.

Yeah, Megan, thank you so much for spending some time with us today answering all of my questions.

This was a really

I've enjoyed it.

yeah, this was a really good conversation and you Provided us with some great information, but also insights into some of your experiences as an OT with clients and how, OTs really help promote participation in meaningful activities.

So, thank you so much for being here with us today.

Thank you for having me.

This is a podcast produced and developed by the Society for Alberta Occupational Therapists.

Our podcast is hosted by occupational therapists and is intended to educate and get listeners excited about all the different ways that OTs support health and well being for people at all stages of life.

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