Hello, everyone.

Welcome to episode number six of Beyond Barriers, Navigating Health and Function, developed and produced by the Society of Alberta Occupational Therapists.

I am your host, Pam Hung, and we are talking to occupational therapists that work with clients in different practice areas to learn more about the many ways occupational therapists promote engagement and participation in everyday life activities.

Today, we are speaking with Naylin Jaffer, an occupational therapist working in inpatient adult rehabilitation at a facility here in Edmonton.

Today, we will dive into what brought her to this area of OT practice, how she has supported clients and their families in participating in everyday life activities and navigating life transitions while living with a health condition, as well as how OTs are unique health professionals in a rehabilitation setting.

Welcome, Naylin.

Please tell us a bit about your work as an occupational therapist in inpatient rehabilitation with adults and what drew you to work in this area.

um, my clients or patients are primarily, spinal cord injury patients or general neurology patients.

and when I say general neurology, things like MS, GBS, neuropathies.

so they're quite involved patients in terms of their diagnosis.

sometimes they have had complex medical, issues and surgeries and treatments, in acute care before they come to us, in our rehab setting.

and the goal is often to get more function back or learn new skills to adjust to the new level of function they have.

and I've been drawn to this, area because it is actual rehab, like it is very much, helping the patients figure out how to either overcome their challenges or give them alternatives in terms of modifications or strategies to help them function better.

I find it really rewarding.

I see anything from patients who have had, paraplegia, less functioning of their legs and now they're in a wheelchair.

or it could even be central cord syndrome, which is also spinal cord injury.

and that individual has limited use of their arms and hands.

or even, MS individuals, and they have one sided weakness, and also some cognitive and visual perceptual issues as well.

Yeah, so quite a diverse range of range of clients that you see.

Yes.

What are some of the challenges that your clients face?

you mentioned they come to you from maybe a hospital setting for some extra rehab prior to going home.

What are, yeah, what are some of those challenges that you work with clients on?

so definitely the number one challenges are, they have a physical change, so they have now limited function either in their body, upper body, lower body, so they could be limited in terms of what they can do now, as opposed to what they were able to do before.

Um, so for example, they might be using a wheelchair now, so how do they get from their wheelchair to their bed?

so some of the things that, they will be learning with us is how they, can slider board transfer from wheelchair to bed.

and then this is a good example as well.

So how do they function day to day?

Like, how are they going to get dressed?

How do they manage bowel and bladder?

Figuring out, IADLs as well.

for example, how are they going to be managing in their home, cooking meals, getting to their appointments, managing their medications, will their house be accessible for them to go back to?

And if it's not, then what are we looking at for, in terms of what we can do for modifications or are we looking for a different place altogether?

as well as like equipment and what they need to be able to manage their day to day function.

Yeah.

And, from what you're saying, it's could be any of those challenges could be anything from, what you might do in the morning to get ready for the day, anything someone might be doing throughout the day, and then.

that kind of wind down part of the day as well, managing things in the community.

As well as home.

what are some things that you do as an occupational therapist to help people that experience these challenges?

I know you mentioned a couple of things in terms of, maybe having people learn different ways of transferring or what are some other things that OTs do?

so in our role, we definitely look at, their day to day function.

So are they able to dress themselves or what strategies can we teach them, to be able to, for example, put on pants when they have no, function?

Or if in the case of their hands, if their hands aren't working, what is it that we can help in terms of strategize how they can get a shirt on, do their buttons, that kind of thing.

We're also looking at, again, bowel and bladder with nursing staff.

so a lot of our patients will have impairment in bowel and bladder function.

They might have a catheter.

They might have to do intermittent catheterizing.

They might have to have a bowel routine.

So what can we do to help them figure that out with nursing as well?

Helping Us.

so do they need a specialty commode?

what is it that we can do to enable them being able to maintain as much as possible that normal day to day function?

And then we're also looking at how they're going to function again at home.

In the community, so what were their roles before?

And can they return to some of those roles as independently as possible?

Or if they need to access community, whether it be school, work, what can we do to help them figure that out?

As part of my role, this is once a month or twice a month.

I also do driving assessments and it might not be necessarily with spinal cord patients, but what can we do to enable them being able to access the community in terms of driving?

So we're looking at all these things to help figure out, what we can do to help these, individuals be as independent as possible, live fulfilling, normal lives.

and

and, just being able to support them in all the different, roles they might play in their day to day life too, particularly with something driving, for example.

I'm just curious, how long might you work with a client or how long might, your patient, And client might, stay in the rehab facility for, I'm sure it varies though.

So,

yes.

so it definitely varies.

there is a way for our program to calculate how many days or, weeks a patient gets for their rehab.

But basically, the more impairment they have, the more time they get.

someone who has, lots of function but some minor issues with their hands and arms might get a few weeks, so three or four weeks, for example, as opposed to someone who has Significant impairment, maybe needs lots of help.

Currently needs two people for sitting up or for any care activity.

there may be a mechanical lift for transfers.

They might even get two months or even more, for example.

So again, it varies depending on impairment and there is like a system that is used to calculate what time frame a patient will get, so how long we get to work with them.

But having said that, there is some flexibility as well.

So if a patient continues to show lots of progress, they're showing that they're still improving, they're meeting all their goals, they're exceeding in a way, that date for discharge may change.

as long as, we're targeting specific rehab goals.

Yeah, for sure.

And I can see how it be, how it can be really variable depending on to what sort of, needs they might have in their environment or space when they go home, right?

whether they live in a two story house or a bungalow or, or that sort of thing that.

I feel could adjust things or needs for getting equipment and that sort of thing as well.

Um,

people, within your client support system, whether that's family members, other caregivers, or other people that might be, involved in a client's kind of social support system.

Definitely.

I think there's no two ways about that.

we rely on the patient and their supports to help us figure things out.

Definitely.

There's no question about that.

for example, family members are key.

And you know what?

They help us directly.

So let's say, for example, the care needs are higher for this individual now.

They help us figure out how that will look and what supports they can help with.

for example, if it's dressing, Are they going to be more involved in helping set up the clothes in the morning or help more in the evening if the individual is more tired?

Are they willing to do that?

Do they feel they can support that?

So that is their direct way of helping, but they're also helping us indirectly.

So an example I can give is if they, if the individual needs a lot of home modifications or changes to their home, I think the family has like a significance say in what changes or what doesn't change, because it has to work for all those parties.

it can't just be that we're looking at what works for, our client or patient.

It has to work for the kids in the family.

It has to work for the spouse, the partner.

It has to work for everybody who's in that home.

So they help us in a lot of ways directly, indirectly as well.

Okay.

Do you work with any, Like community based organizations at all?

Yes, we do.

So we work with, a lot of times with Spinal Cord Injury Alberta.

Okay.

So it's an organization that is very community based.

they have a lot of, supports, so peer supports for our clients and patients.

they help navigate some of the things that maybe we might not even be able to, give answers about.

So for example, a good example is travel.

So how do you problem solve traveling issues with a wheelchair?

How do you problem solve a bowel and bladder when you're somewhere else from home?

they provide lots of peer support, but they also provide, equipment through donation.

they have, good, group supports as well.

and yes, they are very valuable in terms of our meetings and connections for our clients and patients.

Yeah.

And I imagine it's probably a good support for them once they're, once they transition to being at home, too.

That's

Yes, definitely.

how does your role as an OT contribute to your clients or patients health and wellbeing?

I feel like you've mentioned a few things already.

but what else?

Yeah, so I feel as an OT, our bread and butter really is that function and day to day function, especially.

so it's everything that you can think of.

Basically, the individual has to do in a day.

I find this can vary.

Every patient's goal can vary.

some people have, families, they have kids they're taking care of versus other individuals who are older, may not have those responsibilities.

They're more looking at maybe going out.

Just once in a while.

so whatever that goal may be, we work towards achieving that with our patient or client.

some patients may have simple goals like being able to make a meal in their home, bake something special for a dinner event.

for some of our other individuals, they may be being able to get back to work.

so it can really be different, and I think sometimes as OTs, we have to think outside the box and be creative, connect with our social workers, connect with, Spinal Cord Injury Alberta.

connect with other team members and see if we can figure out what can work.

another example could be we can connect with our rec therapist and see if, like a special goal a patient might have is achievable in terms of their recreational supports and and yeah, just basically connecting the team together and problem solving in terms of that function and day to day, activities piece.

One, two,

just.

Helping people navigate through this significant life transition they may be going through.

I mean it's, I think it's really cool how OTs look at all of those different factors, as things that we have to think about and consider when we're supporting people to do the things that they want to do, because it all matters really.

so we talked a little bit about, working with family members or caregivers.

you also mentioned you, you do work with nursing.

but how closely do you work with some other health professionals?

where in the facility that you work, what healthcare professionals are those?

Yes, so we work as a part of a team.

we definitely have, physiotherapists on our team.

So those are the people we work with closest, I would say.

some of our work even overlaps.

and so when we're looking at the physical mobility piece, we're sometimes co treating with physiotherapists, and doing sessions together.

but we also on our team have, social work.

the social workers, workers help us navigate, funding.

They help us navigate, home environments as well.

finding new accessible places.

we also work with, recreation therapy.

We work with our medical doctors, especially our physiatrists, so specialists in rehab.

We work with our unit managers.

We have therapy assistants on our team.

Our team is huge.

I think I'm forgetting a few.

I think psychology is big as well, so we have psychologists on our, on our unit.

So yes, yeah, we definitely don't work in a silo.

our team works together.

We meet regularly to discuss issues that we may have or barriers and, help put, solutions together as opposed to it just being one discipline doing all the work.

He's a great

Yeah, of course.

And I can see how when, you're navigating multiple different things, how helpful that can be, in other, in some other recordings that we've done for the, for, for this podcast.

A lot of people have talked about that overlap with, with, you know, other healthcare professionals.

You mentioned, physio is one of those.

how do you navigate that with the physiotherapists?

We do have a very close connection with them, and we know them at a personal level, too.

Thank you.

the physios on our team are our direct partners.

So I find a lot of the navigation is open communication.

So, for example, we're working on transfers with a client or patient, and let's say it's slider board transfers, but that individual needs more than one person to work with them.

They're a heavier, Transfer, for example, they need two people.

sometimes we collaborate with our physios, connect, ahead of time and say, you know what, can we do this session together?

what time works for you?

Can we do the session together where we're looking at the client, doing a slide of word transfer so that, Not only do I have that help, of a second person, but we're also, talking and connecting with the patient together and aligning the goals, for rehab.

I find that our physios are very flexible.

They're open to our questions.

I find that we do divide our roles a little bit.

So as an OT, I'm focusing more on the arms and the hands when it comes to treatment.

we're treating shoulders more, a little bit more than most other OTs would.

But at the same time, if there is something that I feel my physio needs to look at, I will definitely be like, can you help me out with this?

this patient's having this issue and there's a lot of pain.

Can you help me figure it out?

Can we problem solve together?

And then, yes, the physios will be looking more at, the lower body, the legs, function in terms of that.

and you know what?

It's unique on our unit that the physios actually are hands on with wheelchair mobility and they help prescribe some of that as well.

So our roles really are interconnected.

There's no separation.

and that communication with our physiotherapists are, it's so essential.

It's so important.

and, we definitely have to work together.

Yeah.

And especially even being able to, you know, see someone together, you might, be able to the client can kind of.

answer the questions from both of you and both of you get the answers, which is always key when, we don't necessarily need to have a client telling their story so many times to everyone.

say before

That's at least one thing that I've seen in my own practice in acute care.

Yeah,

I can definitely add to that.

yeah, we do sessions together where we're talking about goals and what's realistic.

sometimes patients may have goals that are not necessarily, unrealistic, but maybe in the timeframe that we see them, they might not be truly achievable.

So having that discussion together with our physio partners, it really helps put things together for the client or patient and helps solidify what we're working towards and what's realistic during the time that they're going to be with us.

Uh, Um,

make sure that, a patient or client isn't necessarily overwhelmed with all these different goals to work towards, which can be a lot if you're, if there's multiple different, providers or disciplines that are working with a client as it may be in where you're working.

yeah, and it's interesting how there are so many different ways of.

Addressing that professional overlap with other professions.

So it's, yeah, it's cool to hear how different they are in different studies.

And I think, too, it makes a difference if, those other healthcare providers are directly on your team in the same space you work.

I think that is a bit different than, someone in the community having to connect with maybe a different clinic and a professional there that communication is probably different than than when a whole team is situated within one program.

Definitely, like, I, I can't say enough about having the team power.

we have, direct connection with our social workers, our recreational therapists, you name it.

we can.

connect with them right away via phone, connect care.

it is crucial, in terms of problem solving, helping the patient in the moment instead of it being something that has to, be a discussion down the line.

Um, yeah, it just is so essential, and we're so blessed to have the team together in one space.

Thank you.

Yeah, that's great.

What are some of the challenges that you've faced as an OT working in a rehab facility?

That is a good question.

Um, some of the challenges I think are, so I think a lot of the challenges are systemic.

and I'll just, not delve into them too much, but speak to them briefly.

one issue I find is with, our system, there's lots of bed pressures.

So there is, indirect pressure.

on us, as OTs, as rehab professionals to work faster with our patients and that's not necessarily in our favor sometimes because we know, patients and clients need time, not only to get better, but to adjust.

so we sometimes run into issues where we have to be advocates, for our patients.

people, our patients and clients, and really, push, in terms of more time or, problem solve in terms of what we can do, to give more opportunities to our patient to practice certain skill sets.

so that's number one, I think, is just systemic pressures.

I think there are some small other issues, in terms of the OT role, for example, clarity in what OT does.

but I think that's, Way minor compared to some of the other systemic issues we're having.

I think they're across the board.

it's not unique to us per se.

but yeah, I would say definitely, bed pressures and pressures to get people going faster.

Yeah, and, you know, definitely challenges around, you know, resources to be able to do that, too, is, is probably something that's, that's come up as well.

I know that you work with a lot of other healthcare professionals, so if you think about even I don't know, maybe Health care providers in other settings, or maybe your own setting or, even just whether it's community organizations you work with, but what do you wish that other people knew about OT?

wish they knew that we have diverse roles, depending on where we're working.

sometimes OTs get seen in one light and one light only.

and usually that depends on what the experience of the other healthcare professional has been in the past.

and I want I think I would want others to know that OTs can do different things depending on where they work, and that we are very diverse in our roles.

so for example, most common would be that people think OT, is related to equipment and equipment provision.

that could be just one minor role.

We do a lot more than that.

and again, like in mental health, like OTs do, a lot more cognitive, psychosocial assessments and treatment, which may not be something that you necessarily see in my role.

we do a little bit of that, not a ton.

And so our roles are very diverse depending on where we're working.

I Would

Be

there is.

So many people that I've talked to that have, maybe met or had a family member work with an OT in a certain setting, like you say, and that then becomes their understanding.

And I think in some ways, it's a, it's a strength of OT that we can work with.

all different populations, all different health conditions, all different ages, but then that kind of makes it tricky to sort out what our role is, based on, based on people's understanding of it.

yeah.

What are some ways you think could help address any misconceptions or misunderstandings of the OT role in practice?

That's a good question.

I think, From my view, I think we're on the right track as a profession.

I think we are, making a lot of noise in terms of awareness.

I personally, at a personal level, feel the more we talk about our roles as OTs, talk about what we do in the specific setting that we are working in, the more awareness there will be.

This podcast is amazing in that it's helping that awareness too, and create some, dialogue.

I think for most other healthcare professionals, they tend to know, generally about OT.

They might not be 100 percent in terms of that specific role or unit.

there might be things that they didn't think OT did that, OTs actually do, but for the most part, they have a general idea.

I think more concerning is the general public, in my view, and unless you've really had that connection with an OT, where you've had to interact with an OT, Most people find it hard to understand what our role is and what we do.

so when we do have those connections with people, in the community or family members or caregivers, we should be loud in terms of what we say about our role and how we're, um, connected to providing, um, not only like quality care and treatment in terms of getting people functioning, getting them mental health services, getting them back home, supporting them in the school system.

We should also be like really encouraging that awareness that you know OT is diverse and that our roles may be different depending on where we're working.

Um,

what other health care providers might be available in that setting too, because that role overlap again is, it's kind of a strength, but it's also a challenge because there are, so many different roles we can play that, navigating that can sometimes be tricky, but that education piece is so important.

You're right.

Um, so, I mean, given that you work in a.

Inpatient Facility.

how do you typically get referrals?

Do all of your clients tend to come from the acute care hospitals in Edmonton or do they come from other places too?

What does that kind of look like?

our referrals are mostly, through our physiatrists, so our medical specialists.

they go out, and do consults, But also, as a team, we do see patients, in an outpatient clinic as well.

So most of our clients do come from acute care and the hospital system.

They've been flagged by our physiatrists to come for more rehab.

but we do get referrals through, our physiatrists.

primarily through that outpatient clinic, as well.

And those could be community individuals, people living in the community.

we've also had a few that have, been patients, in other facilities, long term care sites.

I think primarily what, is looked at is whether there's potential to improve functionally and is there specific goals that can be achieved, in the time frame that they would be here with us in our, site in our inpatient setting.

and so yeah, I don't think as OTs we have direct say in who comes to us, but, Sometimes, we, do play a role in the outpatient setting.

When we do see those patients that could benefit, we can advocate for them to come in and, be part of our inpatient program.

This is the

So, a few different ways that people can, come through.

Can you share an example of a time when your role as an OT in a client's care led to improvements in their function and quality of life and what that looked like?

Yes, definitely.

so I'm thinking of two examples right now.

So one was definitely an inpatient who came to us from, an acute care setting, young individual, very young, 20s, and was, inpatient.

diagnosed with Multiple Sclerosis, or MS, and she had a business that she was running for work, and she also had a partner at home.

They lived, Not rurally, but on the outskirts of Edmonton.

and so when she came to us, there were a lot of concerns in terms of her returning home and being safe, being able to manage.

even in terms of her sitting, she didn't have great balance, unless she was supported.

and of course, she, at that time, needed a wheelchair for mobility.

She had minor impairments with her upper body as well as some dexterity issues with her hands.

And so as a team, we worked towards, improving, her sitting tolerance and her sitting ability.

we got her going in terms of her hand function.

She was doing, hand cloths, working on dexterity.

We also worked in terms of progressing her in doing transfers.

So she started off doing slider board transfers with us.

And then she also worked with us in terms of dressing and matching bowel and bladder.

And she actually improved quite a bit.

She got to a point where her transfers were really good.

She was able to manage some of the basic, care needs that she had on her own.

Um, and we got to a point where we got her going home on short passes.

And then eventually that even got to a point where, we problem solved some of her issues at home, her issues with accessibility, getting to the bathroom, and she was going home on weekend passes.

and by the time she went home, At discharge, she was able to take a few steps with a walker.

Vizi had a great role in that.

And we were able to problem solve issues she would have in her immediate environment at home.

And she was able to do simple meal prep, be able to be home on her own while her spouse was working, and then her eventual goal again was to go out in the community, resume her role, in her business, and, We didn't quite get there at discharge from inpatients, but she was on that course.

So yeah, she was a very positive outcome for us.

And you know what, it was really an inspiration for me.

personally as well, because when she did come to us, some of the comments from our team were that maybe she will be a wheelchair user, might not get to the point where she's fully independent.

And so, um, getting to a point where she's, um, so independent, um, it was really, um, inspiring.

And as OTs, we look for that.

We look at, how can we get patients to doing you know, the best they can, doing functional roles, in the home, being, able bodied members of society.

and so this was, like, full circle.

It was really, a good feeling as an OT to have that we were able to work with her and get her, to that point.

Having said that, I also want to talk about another client or patient I had in the outpatient setting.

he was, an elderly gentleman.

He had his spinal cord injury really early on.

I think he was in his late teens if I'm correct.

but he, had gone on to live with his spinal cord injury.

he had gone to university, had a few degrees, was a very, involved community member.

He worked, and so when I saw him it was just a point in time where he was having issues, that were Really, spinal cord injury issues, pressure injuries, but he had lived his whole life, and was very adjusted to his, his spinal cord injury.

And at that point in time, it was inspiring to see, his connection with his spouse.

and, we just got talking and they were describing this time when they had gone on a vacation to Hong Kong.

And, when I think about that, I get nervous about exploring a new culture and being in a new environment.

And his stories were really amazing.

And they're problem solving in terms of like accessibility, elevator use, like tiny elevators.

it was just.

Yeah, like our patients are sometimes so creative and they're just like out there doing normal things that even as an OT sometimes I have anxiety doing.

and so yes, definitely.

I feel that as OTs.

We do help patients, but sometimes our patients help us.

They help us see the other side, help us be able to push the boundaries a little bit, and say things are always possible.

They're always possible.

yeah, for sure.

That's yeah, those are two, like, you know, really interesting and similar, but different, um, stories of where, you know, supporting someone in the short term really helped them to be able to, get back home and do some of those day to day activities, and then maybe move on to some of those other activities at a later point.

And then, an individual who's, lived with a spinal cord injury most of his life and been able to be creative and problem solve, probably in similar ways than we might do as an OT.

that really, I think we learn so much from our patients and clients too, that we often pass on to other ones.

And so sometimes there are.

Yeah, it's interesting actually, like, you know, as we're recording this, um, you know, it's not necessarily October OT month, but the Paralympics have been on TV and my kids have been asking me lots of questions about, how they get their wheelchairs to Paris from Canada and how, what does that look like?

And even just having those conversations with my kids have been really interesting and even eye opening.

Uh,

in day to day life for people that, might use a mobility aid or something like that to do what they want to do.

So yeah, that's wonderful.

so just wrapping up with the last few questions, what is one thing that you think everyone should know about OT?

That is a very tough question.

One thing.

I would say that OT, is all about, helping people in terms of achieving their functional goals.

so it is definitely about day to day, and, the client or patient that we're helping.

it's very individualized to that person.

and again, our role may be very different depending on what clientele you see.

Um, OTs are dynamic.

We are creative.

we are adaptable.

And by that, I think a lot of OTs work in different roles over their, their lifetime.

Um, and yeah, we really truly look at what can we do to help, individuals or parties or, groups, be the best version of themselves, really.

Yeah, that's great.

And you kind of really highlighted that sort of like, you know, looking at people or groups as, you know, their own entity.

They, they have, you know, their own needs, their own context that we have to think about, um, when we're helping people work.

Work towards their goals.

so just one last question to wrap up.

I'm hoping that there might be some people listening out there that are either interested in becoming an occupational therapist or just, want to really learn more about OT.

But what qualities or skills do you think are important for occupational therapists or for someone who is interested in looking at being an occupational therapist in the future?

Skill I would say would be social skills.

So to be someone who can communicate well, can work with different people, be able to connect with your client and patient or and really be able to create a safe space for them to push their limits and be able to advocate for them.

So when I think about that, piece, I think about, It almost is a partnership between the client and the OT.

Communication is essential.

Openness is essential.

So some of the social skills are very important.

If you are someone who does not like being around people all the time or someone who tends to be more introverted, I think that's This is a little bit more of a challenge sometimes when it comes to OT.

the other things I would say definitely adaptability.

we work in so many different areas, so being able to adapt and problem solve, are very important skills.

It could be also that creativity is another one because, I think with that problem solving, we have to be able to create solutions to problems, be it in the environment of the client or with a task.

so creativity is huge as well.

Yeah, I think I would say those, three are key social skills, adaptability, and creativity.

Yeah, that's awesome.

I love that.

I really like listening to everyone's answer to this question because there are definitely some similarities, but there's always something a little bit different too.

That's great.

thank you so much for spending time with us today and sharing your own experiences.

You've provided us with lots of really great insights on how OTs support and promote participation in day to day meaningful activities.

Um, for people.

So thank you again for being here with us.

And that is wraps up episode six of Beyond Barriers.

Thank you so much, Nalyn.

Thank you.

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.

If you enjoyed this episode, Feel free to subscribe and follow Beyond Barriers, Navigating Health and Function on Spotify, Apple Podcasts, or wherever you get your podcasts.

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