Introduction to Functional Therapy Magazine.

Ed Kaine, Publisher of Functional Therapy Magazine introduces the theme of the magazine.

There are a few ideas here:

1. It's time to lead or be left behind.
2. Function is very fashionable... because it works.
3. The CRAFT Model is a holistic model that will help all health care to provide better care.
4. Many disciplines are becoming more functional and Occupational Therapists must work to lead this. It is our responsibility to guide the world to the optimal health we seek.

I have a significant number of people who are interested in helping define function and health care for the future but I want to open it up to anyone from any discipline to join us and help shape the future of health care.

Please Like us on Facebook https://www.facebook.com/FunctionalTherapyMagazine and contact us through facebook if you'd like more information or to contribute an article or promote your point of view.

Yours,

Ed Kaine, OTR/L, RFT
Publisher of Functional Therapy Magazine

P.S. Please check out www.FunctionalTherapy.org for all the latest articles in health care and therapy topics that we and our readers can find.

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 5

Restoring Balance To The Platform

In the preceding scenarios we reviewed the sources of imbalance, now we will discuss a central principle of Functional Therapy, supporting function.

Let's revisit the model as it is unbalanced by a deficit in abilities. No matter the ability pillar we can upset the balance of functions. Most often healthcare professionals work to restore the physical body, in fact, most of medicine is working towards addressing physical complaints, symptoms and problems. The deficits from mental, social and motivational impairments can lead to similar imbalances.

Let's return to the person with the deficit of the motivational pillar. This might have been caused by a depression or perhaps the depression is caused by the imbalance of functions; by not performing a balance of functions you can lose your motivation. Consider the lack of balanced function as a risk for other deficits.

The CRAFT Model is a snapshot of the status of an individual; consider personal history an elucidation of which caused which, in other words we get to find out if it was 'the chicken or the egg'. I wish to popularize the idea that an imbalance in functions could lead to other deficits any of the other areas. 

In order to most effectively help a person we work to restore balance to function. In this case we depict an external support, possibly a social support, to help restore balance to the platform of functions. 

"The worst place to decide whether to get up and get dressed is in bed." - Unknown  

By supporting a person doing functional things we allow them to use their mental, social, physical and motivational abilities in  functional way. In short, "the more you do, the more you can do." They also engage with their physical environment, social supports, temporal situation and consider their cultural background more deeply. The Functional Therapist and Functional Therapy Associate works to assess the limitations and then seeks to expediently restore balance. The ability to call on the whole model and more gives Functional Therapy its strength.

OTs and Functional Therapists might occasionally find themselves off the course of purely a functional or occupational approach to care; the CRAFT model seeks to help get us back to the value of doing functional things in therapy. We must consider the paths of remediation and compensation as ways to restore function along with external support and means to seek balance in function as a reasonable jump off point for a return to living.

Thank you for reading.

Yours,


Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line. 

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 1

Balance and the CRAFT Model


The CRAFT Model, the Context Related Abilities Functional Therapy Model, is a holistic model for a person living a life. As a concept it is designed to be dynamic and responsive to changes. In this article we will review the model and then focus on our the things we do (functions or occupations) and the concept of striving towards balance.

Lets review the CRAFT Model briefly. The Model is built upon the surface of a globe, this represents the context of the individual. The 3 aspects of context are the Physical Environment, Cultural Background, and Social Supports. If we consider a person in their workplace we encounter the physical layout of the place, this includes obvious things like accessibility with ramps and elevators but also less concrete things like propinquity (the proximity of your colleagues). This ties closely to the social environment and supports of your workplace; who can you rely on, who can you consult and who you can't. This is closely tied to the culture of your institution and to the area of the country in which you live; does work start at 8 am, are there lunch breaks, is overtime expected / appreciated / discouraged, is there a siesta?

Upon this context springs the abilities of the individual; the following are some examples to help you as you consider a person and the various abilities they display. The Physical pillar may be the most obvious, almost all of the effort in medicine goes towards realigning this area. Medications are most often directed at restoring organ function, reducing pain, reducing inflammation, etc.; surgical medicine is primarily focused on physical correction while most exercise and therapy is dedicated to restoring physical strength and structural integrity of a persons physical self. The Mental pillar is also significant as a person's safety and function relates to their attention, judgement, memory, orientation, etc.; more attention has been placed on this as the population ages as conditions like Alzheimer's Syndrome are more prevalent, but brain injury has highlighted coping skills and many challenges even for the very young. The Social pillar governs how a person interacts with others, different from the the social supports, these are the abilities that allow a person to maintain friendships, read others reactions, be empathetic, etc.; autism and schizophrenia have highlighted some of the social interaction disorders but as we know the spectrum from the charismatic to the recluse displays many skill levels. The Motivational pillar embodies those skills that get us up in the morning, ready for the world and its challenges; depression may make its biggest impact on this area, causing a malaise that may prevent a person from using many of the other abilities.

Upon the ability pillars sits the platform of functions or 'things we do', these are sometimes called 'occupations' by OTs. In particular we have three categories: Work, Leisure and Self Care. These are divided by the meaning of the activity; for instance cooking can be for work if you are employed as a chef or are preparing food for your family, or cooking could be self care if you are making a meal for yourself, or it could also be leisure if you are making a recipe from a new cookbook or magazine for a fun change. The meanings of the tasks reflect which category it goes into. Now let's explore an old adage where someone is out of balance.

"All work and no play makes Jack a dull boy."

This is what it might look like on the CRAFT model. What might be the consequences for Jack? Well, we can see that Jack's sleep and hygiene might be suffering, also his creativity may be stunted as he is not opening himself to outside leisure pursuits. He may in fact be a "dull boy." What might happen to his ability pillars, he might most obviously suffer from a lack of exercise and his physical health may falter, there is some evidence that working far too much overtime may lead to other deficits in mental performance, but he may also find himself irritable or lacking motivation. This may then impact his social supports who might be angry about him cancelling the vacation and a wife who is considering divorce.

As you can see, we have a dynamic model that allows us to quickly visualize the state of imbalance that someone is in. Over the next few articles we will explore other imbalances and what we might visualize as ways to help a person back to a purposeful and functional life.


Please leave any questions, ideas, or comments on the model below or email: RFT@FunctionalTherapist.org.

Thanks,



Ed Kaine, OTR, RFT
President of the League of Functional Therapists

"Functional Therapy... the Next Generation of Occupational Therapy."

CRAFT Model - Functional Therapy's Expansion of the Wholistic View of Personhood

This is a snapshot of an interactive presentation we are developing to help consumers and therapists to better understand the interaction of Functions, Abilities and the Context in which we live.

 It embodies a globe which contains the Context of the person; the pillars represent four domains of Abilities; and the pillars support the platform of Functions or 'Things we do'. These are also known as Occupations.

In the interactive presentation we represent external supports by additional pillars and external burdens as weights. The new adage 'The more you do the more you can do!' plays into this system by the performance of functions feeding back into the diameter of the pillars; doing more means you develop more ability. The system works to try to maintain a balance and the old adage 'All work and no play makes Jack a dull boy' is represented by relative sizes of the Functions, with too much of one unbalancing the others.

This is an adaptation of several models with painstaking effort to add a significant reworking so as to avoid infringing anyone's copyrights. The CRAFT model is a reimagining of how we can propound a more integrated vision in Healthcare. It is published under a Creative Commons Copyright and we would ask that you reference us and http://www.functionaltherapist.org/ when you copy or adapt it.

"Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats."
- Howard Aiken

I hope you enjoy this preview of our interactive presentation as much as we are proud to present it to you.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

More about CENT - Principles of Controlled Eccentric Neuromuscular Training.

Now to the meat...

CENT stands for Controlled Eccentric Neuromuscular training. It is partly because the acronym spells something that it was chosen. It will stick in your head and make writing about it easier. (See "Introducing DAP notes" article for some of my views on acronyms.)

Guiding Principles:

Switching between agonist / antagonist muscle actions takes time, effort and is not necessary to start.

The Flexor Synergy exists for a very good reason, if you're a caveman...

Praxis is the key to purposeful movement.

"The more you do the more you can do" (a basic Functional Therapy tenent that applies here too).

Next time we'll break these out a little.


Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists, LLC.

Introducing CENT - Controlled Eccentric Neuromuscular Training.

Today I am introducing CENT - Controlled Eccentric Neuromuscular Training. Over the next few days I will give you more information about this marvelous treatment option I am exploring and developing. I will tell you the foundational tenents of CENT in a moment but first a bit of history.

I desperately want to give credit where it is due... but I can't find that person. Instead I will tell you a brief story and maybe you can help.

About 5 years ago we had a Physical Therapist from India come to our facility. While transitioning and looking to finish requirements to allow her to be licensed here she volunteered on Bridgeport Hospital's Acute Rehabilitation Unit in Bridgeport, Connecticut. Her name was Priti or Preeti. If you read this or know Priti please contact me at RegisteredFunctionalTherapist@gmail.com.

Priti gave a presentation on a paper she had read that she said came out of Australia. From this she identified several things, and I have refined those into this this:

• Work on movements opposite to abnormal synergies (the flexor synergy in the arm).
• Overflow movements or movements outside of the specific action you want should be discouraged and stopped.
• Eccentric muscle actions are often first to recover.
• Work on one muscle action eccentrically and concentrically to keep the patient's focus on a single effort.
• Any muscle action could be your starting point. Just get some success.

Using this on many patients and experimenting in light of other observations I have about stroke I have come to the synthesis known as CENT. I know that the novel direction this has taken would not have occuring without Preeti. Unfortunately I can't find any papers from Australia or elsewhere about this approach. If you read this and think it is referring to something you had heard, read or done I would love to hear about it. Also, if you'd like to collaborate on this and develop your own skills please contact me.

I will give you the meat of this great technique over the next week.

Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists

"Functional Therapy... the Next Generation of Occupational Therapy."

www.FunctionalTherapist.org

Online Meetings And The Next Wave Of Innovation!

The League of Functional Therapists (LOFT) is an international organization. Communicating with diverse people over vast distances is one of our key business needs. A phone is an essential tool, the internet and email have been remarkable enablers... and now online meeting has the potential to be a revolution.

As part of our business software we have a subscription to GoToMeeting. This Citrix product allows up to 16 people to be on a conference call (as a phone call or as Voice over Internet Protocol (VOIP)) and all looking at the same screen. Any attendee's screen can be viewed and or, with your permission, completely controlled. Is this functionality worth less than $50/month? It is to me.

I have met with people all over. I have used this in my work to avoid a long walk, kept all my tools and materials on hand, solved a problem in 2-5 minutes and gone on to do other things. With a software developer we designed together as he taught me what he was doing. With family we have met and planned together and shared photos.

Oh, by the way, the distance is not required... we could do this in the same room too, a few laptops in a conference room and an old fashioned meeting turns into generating work. These capabilities are incredible.

Why then does it seem so routine to people I introduce it to? I have them go to a site (JoinGoToMeeting.com) and put in a meeting number. The program downloads a little file to let it run on your system and the person is asked to put in their name and email address. Then, suddenly, we are meeting together. Instead of talking or planning and sending someone off to do it and report back later, we are able to finish the project in real time together. Just because it's easy doesn't mean it's routine. Can you imagine the possibilities?

If you're an Occupational Therapist and you want know more about our organization we want to talk with you. We can set up a meeting anywhere in the world. So far the farthest East is London, England and farthest West is Queensland, Australia. We want people to understand our mission and objectives and sometimes it takes a guided tour.

So far we have met with supporters and detractors. It is incredible to problem solve together with supporters and it is remarkably inciteful to get feedback from detractors. There is so much that we can learn together.

Set up a meeting with us, learn about the League of Functional Therapists and get to try out GoToMeeting. Contact me at EdKaine@FunctionalTherapist.org.

I'm looking forward to meeting with you.

Yours,


Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists

"Functional Therapy... the Next Generation of Occupational Therapy."

Survey Results Are In - Very Encouraging! A Little Statistical Background.

Over the last few weeks we have been trialing and tailoring our survey. I'd like to thank all the people who helped us by taking the survey. In the end we had a very good tool that participants praised as interesting and enjoyable.

Someday I'll tell you about our $49 lesson but right now I'll tell you of ALOFT's wonderful success.

First, a bit of statistical background. In order to make our survey results as generalizable to the public as we could we sought to have a stratified random sample. The factors we decided on were that we could accept a 5% error rate in the responses. Also we wanted a 95% confidence level, or only a 5% possibility that the results could be due to chance. We set our expected variance to require the maximum number of responses by setting it to 50% (as in equal chance a subject would pick one or the other). Then we wanted to generalize this to the population of the U.S.A. These mean that we would have a sample that would cover 304 Million (as of summer 2008) so we added many more and found we could cover the world's population with 385 subjects.

Then again we were only sampling people in the U.S.A. so we can really only generalize to the U.S.A. We went with the higher number to allow internally guided exclusion criteria and sampling methods to allow exclusion from certain aspects of the study based on background factors.

In the end we had 500 completed surveys with 87 partially completed or eliminated due to just randomly hitting the keyboard rather than answering. So, of the 500 we confirmed many of the intuitions we had had and learned several new and supportive things that we had been unable to quantify.

So far it is saying to us at ALOFT "keep going, this can be a very helpful and positive thing." We had several criteria for the study that would have indicated that we were on the wrong track, none of those were evident. We will be sharing different results from the study as we go along.

If you are interested in this data we are interested in sharing it with you in a meeting. We can setup online meetings if you would like to delve further into any results.

Look for our results in the coming days and weeks.

Yours,

Ed Kaine, OTR, RFT
Member and President of ALOFT

RegisteredFunctionalTherapist@gmail.com

Crucial Converstations Training being considered for League of Functional Therapists

Over the last 30 years an innovative company call Vital Smarts has done research to find skills for exceptional communication. It has been applied in particular to Health Care in several settings. At Maine General Hospital they found that the training alone improved care.

Check out: Crucial Conversations® Training Improves Patient Safety at Maine Healthcare System http://www.vitalsmarts.com/userfiles/File/pdf/case_studies/mainegeneral_health.pdf

Just by taking this training their hospital improved in all the following ways.

They took the training across the board and they saw massive improvements.

What could you do if you were a better communicator? How would your health care facility improve? How would your relationships in your work and in your life improve? Who wouldn't be better if they were better able to hold conversations where emotions were strong?

These skills are skills for life. We are considering offering this course for practicing and non-practicing RFT and RFTAs, and our supporter members. This may be in mid 2010 depending on interest. To let you know, the course could cost $995 is you were just taking this training. However; since you are members or considering membership we should be able to significantly reduce that price. We are in dialogue about it currently with Vital Smarts team.

We are very excited about the prospect of offering these life changing lessons to our membership. Let us know what you think about it.

Please check out http://www.vitalsmarts.com/ and http://www.vitalsmarts.com/crucialconversationstraining.aspx?id=frombanner to get more information on these exciting courses.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

This is a very important article for patients anticipating or recovering from ICU stays. In this randomized controlled clinical trial, Occupational And Physical Therapists took ventillated patients through a course of functional tasks. In the process they had a trememdous impact on patient's lives.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60658-9/fulltext

This shows that it is not just about surviving. Healthcare has the technology to save your life, but it's therapy, and particularly "Functional Therapy", that cares about getting you back to a life of purpose and meaning.

Congratulations to the excellent teams at the University of Pennsylvania, University of Chicago and University of Iowa. The effort to take and confirm scientifically things we know (or think we know) intuitively is very appreciated.

Go Therapy, even in this critical and frightening time in a person's life, the worry that you are too sick to do therapy is turned on it's head. You might be too sick not to do therapy.

Yours,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists
http://www.functionaltherapist.org/

Functional Therapy... the Next Generation of Occupational Therapy!

Change... the easy path.

We were having a meeting the other day about how to increase the awareness of Functional Therapy and get more OTs and COTAs to join. We got to talking about how difficult change is. Lindsay Neumann, RFT, said, "Sometimes it's just easier to go along the way that things are. Most times actually."

Well it didn't take long for it to come around to how difficult it has been for each of us to be Occupational Therapists. There were a cascade of difficulties:

1. To learn about the profession in time to choose it as a career - Very Difficult.
2. To explain to your family what you were studying - Very very difficult... because you barely knew yourself.
3. Graduating, finding a job. Not too difficult... because so many people were beat by #1. Therefore there is a huge shortage of OTs. Easy to find job, but...
4. Staffing for OTs is largely influenced by the difficulty that upper administration has in understanding what OT might do. Incredibly difficult.
5. Then, let's mention the many discussions you'll have trying to explain OT. Difficult but fun.
6. Then, your ears perk up when someone says Occupation or Occupational and you wonder if they are talking about anything related to your profession. They aren't. Our definition still hasn't got into the dictionary - difficult.
7. Then you do this for year after year... it was so much more fun when I started. Difficult.
8. Then you get involved with a group who wants to provide an alternative name and change is difficult.

So, the only thing that would have made this easier would have been to do something about it 89 years ago, or 8 or 9 years ago. There is no time like the present. Make the change now and maybe we'll get past some of this stuff.

Please check us out at www.FunctionalTherapist.org and look at joining us. And if you're already a member let's get to work popularizing Functional Therapy.

Yours,

Ed Kaine, OTR/L, RFT

President of the American League of Functional Therapists

Contact us at: RegisteredFunctionalTherapist@gmail.com

Suffolk News-Herald | Occupational therapy a vital healthcare link

Suffolk News-Herald | Occupational therapy a vital healthcare link

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