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Submitted by Lana Mathis, COTA, Therapy Director, Legend Oaks Healthcare, Kyle, TX
“Fanga Alafia, Ashé Ashé,” meaning “good health and peace to you”—a traditional West African call and response—echoes throughout Legend Oaks Rehabilitation and Healthcare in Kyle. During the month of February, drums could be heard in the halls as residents made their way to the dining hall or some moved in their bed. The message that we want to bring with Black History Month is: welcome, everybody.

Traditional African music was featured every Tuesday. One week, residents learned about famous Black Americans while also being exposed to soul and Cajun food all in honor of Black History Month, the first event of its kind to be held at the facility to benefit residents and employees alike. “In my seven years of working here, this is the first time we’ve ever come together to celebrate Black History Month,” said Christina Johnson, physical therapist assistant at Legend Oaks. “It was a collaborative effort. Because of these guys (other therapists), we’ve got a whole bunch of new staff that have great energy, great ideas and enthusiasm for the people and introducing everything to our residents.”

“The music helped benefit residents and employees alike in a myriad of ways,” said speech therapist Rachel Obstfeld. “Really learning about where we come from and why we do things ultimately just makes us care better overall. The patients actually enjoy it; they get excited about it. If you treat your patient like your friend or someone that you’re actually going to care for, you get better results.” Christina reiterated that the music itself has healing components.

The dancing is so connected to the African drumming in our culture. A lot of hip hop dancing originated from African cultural dancing, so I like to say, “Let the drum speak,” because the drum will bring medicinal feeling; it brings spiritual healing; it brings a connection. “A lot of our residents here have problems with their memory and a lot of them have dementia and other neurodegenerative disorders like Parkinson’s. Some people have had a stroke and a lot of the time, that limits their abilities to communicate and engage with the world around them the same way we do,” Obstfeld said. “Music has a really special way to access parts of the brain that aren’t otherwise active…so we really like to incorporate songs to help them know you have peace in your life and peace in your days.”

By Michelle Mitev, Therapy Resource, Monument, South Carolina
Well, this happened… (https://vimeo.com/822770838?share=copy) and was subsequently played in front of everyone at the Leadership Experience! After this clip was played (in front of hundreds!), I received high fives, compliments, and praise. Big “wows” and “How did you do that?!”

What folks probably saw was me! Almost an optical illusion. Up in the air, spinning, upside down. Major smiles. An undeniably cool thing.

There are a few things that I want my peers to know …

I was unprepared. I wasn’t stoked for the early wake-up but was determined not to let my new peer down. I didn’t know what “acro yoga” was until Tyrah laid down and told me to lean on her feet (omg!). It was freezing! I felt incapable. I felt unsure what would happen if I tried. I wasn’t even sure what was happening the majority of the time!

What folks might not have noticed: Tyrah, strong and steady, holding me up. What folks might not have heard: Tyrah, calm and confident, instructing me one step at a time.

I left the beach on a high. I felt SO proud (Did I really just do THAT?). I left the beach changed. I had tried something completely new and unknown to me. I literally and metaphorically leaned on my partner. She literally and metaphorically elevated me.

Growth comes from conquering uncomfortable moments. And we are the lucky ones and ought not to forget it! Within our organization our growth is exponential because of who we are as individuals and as peer groups. We are our best when we steadfastly pursue new opportunities while leaning on our relationships to help us through the journey. I am SO grateful to Tyrah.

I suppose my message is to recognize you, Tyrah; to lean into new and potentially uncomfortable experiences; and to let go. Then take pride in your effort. Practice gratefulness. (And repeat indefinitely.)

By Tara Meyerpeter, OT, DOR, Keystone Ridge Nursing & Rehabilitation, Omaha, NE
America’s aging population continues to increase in numbers as well as cultural diversity. Baby boomers of all races and nationalities are entering our senior living communities. It is important to embrace cultural diversity and accept the different customs that contribute to the make-up. As the make-up of seniors changes, front-line staff are provided the opportunity to embrace new cultures and celebrate multicultural diversity.

Here’s how to get involved:

• Create an occupational profile to obtain pertinent information regarding ethnicity and cultural background following development of rapport and trust.
• Identify ways to incorporate preferences into treatment sessions (such as recognition of prayer practices, cultural preference/practices, and routines).
• Provide your staff with education to recognize and accommodate the unique needs that accompany different cultures.
• Provide activities and programs that offer seniors the opportunity to experience a variety of cultures such as a multi-cultural showcase.
• Provide interpreters for those who need it, especially in medical situations.
• Enable the use of interpersonal skills to demonstrate intentional respect for resident’s cultures.
• Offer residents with opportunities to express cultural heritage and to learn about cultural identities of others.

Keystone Ridge celebrates diversity in a multitude of ways. Recently, our OT Woroud (Rosie) Hudson assisted in creating a multicultural diversity group with our residents. Each week for four weeks in the month of August, residents worked on their project to display at our Multicultural Showcase. The residents met every Tuesday for approximately 30 to 45 minutes in preparation for the final presentation. The residents were provided with the level of cognitive assistance needed to fully engage and become immersed in research. Research included reading and locating pertinent information in printed article form and on the internet, locating images to add to posters, and cutting/pasting and organizing printed information on a tri-fold poster to represent countries. Most residents chose countries from which they had ancestry, while others chose countries related to personal interests. Each session, residents reported the history of their country, geography, traditional food and attire, art/music, and shared past experiences. They determined what artifact would be showcased to represent their country, whether it be food, attire, music, or a video displaying their country.

These activities allowed residents to take pride in their accomplishments and promoted an overall sense of both independence and interdependence, which enhanced their quality of life which enhanced QOL. The residents were excited and looked forward to attending the next session/workshop to continue to work on the final project. Residents were motivated to get out of bed and attend workshops during program, which was a motivating factor to increase out-of-bed and out-of-room activity to decrease the risk of excess disability and sensory deprivation. The most powerful benefit accomplished from this program would be the reminiscing-building opportunities developed during the sessions and at final showcase. Residents were able to tap into long-term memories of past experiences related to culture and past traditions and enjoyed sharing past experiences with others.

Countries exhibited included: Italy, Mexico, Poland, Germany, Jordan, and Lebanon.

By Mark Milligan, ADOR, Lake Pleasant Post Acute Care, Peoria, AZ
For my Capstone project, I created a new and improved group therapy sheet to help inform the CNAs on the patients that had group therapy that day.

We have had a lot of mishaps with registry CNAs getting patients up, ready and on time for their group therapy sessions during the week. When I brought the issue to their attention, they had a lot to say. Some registry CNAs told me that they were unsure of how the patient transferred and were unsure of which therapist to talk to because they didn’t know who was who. They were unsure of what time to have them up and ready by or when they should start the process of getting the patient up, seeing how some patients take longer than others. This was causing a lot of stress and more work for the therapist team and our core CNA group because they were having to help a lot more.

With this information, I wanted to create a system where there was little to no gray area when it came to getting our patients up and ready for group therapy. I wanted this new system to help our registry CNAs and our core CNA group as much as possible. I added four total boxes with six rows (one for each patient). Each row consists of a box where we can write in the patient’s room number, their transfer assist level, and what assistive device they use. I added the therapist’s name at the top so that the CNAs knew exactly who to contact if they had any questions or concerns. I also added the time at which the group would start. I put two boxes side by side and color-coordinated them to show a therapy team (PT/OT).

Typically, at Lake Pleasant, when one discipline determines a clinically appropriate group, the next discipline will run a group with most, if not all of the same patients. I would leave this new sheet at the nurse’s station next to the appointment sheet. I did this because the CNA’s often check the appointment sheet throughout the day to see when patients need to be up and ready to go. This would ensure that all of the CNAs would see our therapy list.

Implementing the spreadsheet has brought more efficiency to both our nursing and therapy teams, and as a result, our ability to deliver services in a group has increased. Some feedback I received from the CNAs was that they loved the new system. They expressed how it helped them to manage their time better and to go into a patient’s room confident in knowing how to transfer them safely. This system helped to build a better relationship between the CNAs and our therapy team simply by reducing any miscommunication between the two teams. A lot of the times, things happen due to the lack of communication between teams, and this sheet has helped to minimize that by showing our CNAs exactly what was needed.

By Tara Meyepeter, OT, DOR, Keystone Ridge Nursing & Rehabilitation, Omaha, NE
Keystone Ridge is a facility with a typical census of 72. Keystone is unique in the population in which they serve. Most typically, we serve residents who suffer/experience diagnoses that include homelessness, drug/alcohol addiction, and mental health disorders. With such disorders, we often see an increase in adverse behaviors, including self-isolation and denial of care. Our therapists have embraced looking at residents using an holistic approach. How do we serve their needs?

In one recent referral, a: 76-year-old female presented with a diagnosis that includes major depressive disorder and anxiety. She was referred to therapy due to her refusal to complete ADLs and her adverse behaviors (yelling, screaming) with caregivers. So often, we may look at this resident as “that’s just how she is.” The challenge to the team is, what can we do for this resident? Are we looking at the person as a whole?

In what way can we bring purpose? How do we increase their quality of life?
● Start building rapport. Be consistent. Trial different times to determine the most appropriate part of the day based on patient engagement.
● Establish likes/dislikes. A great tool to use is the Interest Checklist or Life History and Profile.
● Why are they refusing care? Is it more than behaviors? Find out their why. Most often it is more than just refusing. We used a sensory profile to determine sensory needs.

We have developed a friendship and trust. I discovered that my resident is sensory avoiding. She prefers the dark and is highly sensitive to clothing. She is very deconditioned from years of self-isolation and refusal to get out of bed. As a result, she is a high fall risk; however, she has good insight that it is not safe to walk alone. We determined her love for animals, specifically elephants. To work on sitting balance, we would watch the virtual zoo on the computer while seated at EOB. Little by little, I gained her trust.

Through these approaches, my resident has allowed me to cut off 12 inches of unkept matted hair, and most importantly, she is accepting my help with ADLs like showering. Now this took time, 1.5 months in fact! This is the person most often people chalk up to “That’s just the way she is.” My challenge to everyone is, are you treating at your optimal level of practice? Are we looking at the whole person?

By Elyse Matson, MA CCC-SLP, SLP Resource/Ensign Services
It is estimated that nearly 100 million people have contracted Covid-19. Long-lasting symptoms occur in nearly one in four people, even when they were not hospitalized. The primary complaints of those with persistent issues are brain fog and cognitive fatigue. That means millions of people are walking around with cognitive issues likely affecting their lives.

In a recent conference from ASHA, Rebecca Boersma, SLP of George Washington University Hospital, described a new outpatient treatment protocol to address these issues. These new patients are primarily female with a mean age of mid-40s. Recovery from these subtle but debilitating deficits does not follow the normal recovery timeline and tends to be remitting and relapsing in nature. Prominent deficits including attention, working memory, word finding, cognitive fatigue and processing speed.

Boersma utilizes assessment and treatment approaches common in the post-concussive population, including motivational interviewing, collaborative goal setting, and a variety of scales and tools to assess patient perception of communication, fatigue and cognition. These include the Modified Fatigue Impact Scale, the LaTrobe Communication Questionnaire, and the Multifactorial Memory Questionnaire.
Treatment focuses on a person-centered approach and utilizes proven treatments such as the meta-cognitive strategy, dynamic coaching and managing fatigue.

In our outpatient programs, we have an opportunity to seek out and help some of those suffering with Long COVID. Is this a program you can implement in your facility? For more information and to obtain the protocol, email Elyse Matson ematson@ensignservices.net.

By Elyse Matson, MA CCC-SLP, SLP Resource/Ensign Services
Swallowing is one of the most complex actions we perform, involving more than 30 muscles and nerves. The average person swallows approximately 600 times per day — about 350 times while awake, 200 times while eating, and around 50 times while asleep.

Dysphagia indicates any difficulty or problem with swallowing normally. A swallowing disorder not only affects safety but also quality of life. Dysphagia is a serious medical condition that affects between 300,000 and 600,000 individuals in the United States each year.

Common signs and symptoms of dysphagia include: difficulty with weight gain (in children), unintentional weight loss (in adults), coughing during eating/drinking, recurrent aspiration pneumonia, food/liquid coming out of the nose/mouth, and a feeling of food remaining “stuck” in the throat/upper chest, to name a few.

Dysphagia is associated with a wide variety of conditions, including congenital and developmental disorders (e.g., cleft lip/palate, Down’s syndrome), head and neck cancers, pulmonary conditions (e.g., chronic obstructive pulmonary disease), and a variety of neurologic conditions such as stroke, dementia, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Parkinson’s disease, muscular dystrophy, cerebral palsy, and many more. Since it is a common symptom in many of these diseases, it often goes unnoticed and is often under-reported, despite having significant consequences.

Complications and consequences of dysphagia include pulmonary aspiration, malnutrition, dehydration, pneumonia and even death. In hospitalized patients, dysphagia has been shown to significantly lengthen the hospital length of stay and is a negative prognostic indicator. In addition, those with dysphagia often report a feeling of isolation and depression, as many are no longer able to take part in social gatherings that so often revolve around eating and drinking. It is estimated that dysphagia is responsible for between $4.3 to $7.1 billion in additional hospital costs per year. Despite the significant detrimental impact dysphagia has on health and quality of life, only a third of those afflicted seek medical treatment.

Assessment of dysphagia frequently includes a clinical assessment and instrumental assessment. A clinical bedside swallow assessment is typically completed by a speech-language pathologist (SLP) and is used to describe the characteristics of the individual’s swallow function, determine the presence/absence and characteristics of a swallowing disorder, determine the safest route of nutrition/hydration, and help provide additional recommendations for an instrumental assessment and appropriate treatment. The two most common instrumental assessments are fiberoptic endoscopic evaluation of swallowing (FEES) and modified barium swallow study (MBSS).

Once a diagnosis of dysphagia has been made, the healthcare team determines the most appropriate plan for treatment. Management of dysphagia may involve medical/surgical intervention by a physician and/or behavioral intervention by an SLP. The focus of any dysphagia intervention is to optimize the swallow to be as safe and efficient as possible, as well as to maximize the patient’s quality of life.