Friday, August 17, 2012

Horses & Friends

In observing occupational therapy (OT) sessions in our Green Therapy Pavilion (CORF), I begin to understand the breadth of treatment this therapy offers to its clients.  An “occupation” is considered everything that’s meaningful, purposeful, and/or functional for a person that s/he does from the moment they wake up until they go to bed.  I don’t know about your day but for me, that’s a lot of stuff!  From household tasks (making a bed, making breakfast, cleaning up dishes, turning on and off lamps, cleaning house) to self grooming habits (brushing teeth, washing face, brushing hair, getting dressed, bathing, toileting, applying makeup, shaving) to communication  (social skills, computer skills, writing, operating a telephone, taking messages) to leisure activities (fishing, crafts, baking, pet care, playing with toys).   Taking into consideration the outpatients’ values, interests, history, roles, routines and needs, OT examines the limitations that may be preventing or challenging their participation in daily activities.

Do you realize how complex the process of learning is? The brain is a sophisticated organ, the human computer if you will.  Many cognitive skills contribute to both academic and occupational success.  Critical skills include attention, working memory, processing speed (how fast we figure things out), long-term memory, logic and reasoning, and visual and auditory processing; all are interdependent though they often are integrally used in their work with other skills.  Individuals with brain injuries (cerebral palsy, CNS dysfunction, autism, epilepsy, etc.) experience “malfunction” in how their brain processes information, pays attention, reasons or remembers things.  Jamie, the young woman I observe in OT, experiences what I call “cognitive disconnect,” a very non-medical term.  She struggles with cognitive reasoning, social etiquette and attentiveness to details. 

One of Jamie’s OT goals in working with her therapist Jill is to learn social appropriateness. 
Jamie loves horses.  And the television show “Friends.”  And socializing.   One day prior to her appointment, I found Jamie sitting in the lobby waiting for Jill.  I decided to wait with her and take the opportunity to learn more about Jamie outside the therapeutic setting.  As we visited, I better understood the social aspect of her challenges. 

After the obligatory preamble of “how are you” exchanges, Jamie suddenly launches into discussion about a horse, who the brood mare was and its bloodline.  Mildly off balance by the sudden, disorienting flow and rhythm of the conversation, I struggled to track Jamie’s line of thinking as she jumps around within the exchange.  She tended to talk fast, sometimes mumbling her words.  Once the topic came to a pause, I asked Jamie if she owned a horse.  No, she said but she rode them.  Familiar with a local organization called Dream Riders of Kentucky, a therapeutic riding program for individuals with disabilities, I asked if she participated in their program.  She does, and off we go again on another conversational ride as she names all the horses’ she ridden, which are her favorites, one that recently died, and other particulars she felt important to share.  Jamie even pulls her cell phone out to show me a photo of a horse and launches into more details about the horse and its personality.  I relax in resignation to simply listen.  She loves riding horses with Dream Riders; she plans riding again later this summer. She doesn’t work; she goes to a pet store where she volunteers to help with the animals; she really loves animals.  She’s a huge fan of the TV show “Friends;” she stays up late watching the show; she’s tired.  Her sister is an OT therapist in CORF.  She lives with her mom; she goes out with a gal to do fun stuff in the community.  She has a boyfriend who she says better not make her mad.  (I did manage to inject that I’ve yet to meet one that doesn’t, wishing her luck with that one.)  She wonders aloud where Jill is; she tells me she’s getting old, and she’s tired.  She shares what happened on the “Friends” episode; she thinks Joey’s cute but says he’s a mess.
And all this in the five minutes we spend waiting on Jill.  Jamie loves visiting with people, and she’s a charming young woman that grabs your heart with her openness, honesty, and compassion, especially for animals.  This conversation offered me greater insight to what was important to Jamie, and a better understanding of her social challenges. 

With Jill’s arrival, we move to Jamie’s OT session where today’s activity is “Survey says!”

In the Next Blog Entry: Survey Says! - Jamie misses or forgets . . . . to say “Excuse me” but launches into “Hi, I’m Jamie.”  Sometimes, she goes right to the question . . . . without introducing herself.

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