Author: The Rainbow OT

Hey! Welcome to my blog!

My name is Devlynn and I am a traveling occupational therapist who is passionate about inclusion and representation of the LGBTQIA+ individuals in the healthcare system.

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OT and Transfeminine Equipment: Breast Forms, Gaffs, and Tucking Oh My!

Transfeminine equipment or equipment for those with feminine gender expression among people assigned a male sex at birth, particularly transgender and gender non-conforming individuals may include: prostheses, breast forms, gaff, tape, tucking, padding.

Padding: Padding refers to the use of undergarments to create the appearance of larger breasts, hips or buttocks. Padding may also assist in minimizing dysphoria.

            Some padding-specific garments include:

–       Padded undergarments: Typically, useful for facilitating appearance of wide hips or full buttocks

–       Bras with pockets: Also known as mastectomy bras, they are designed to accommodate breast forms and other associated prostheses

–       Padded bras: May be preferable if breast growth is present but not at the desired size.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a breasts, penis, scrotum, or other anatomy.

Breast forms: Prostheses that have the appearance of breasts. Typically made of soft silicone gel and adhere to one’s body or are placed in a bra. Can be considered a form of padding.

Tucking: Tucking is the practice of arranging and supporting external genitals between the legs, including the penis, scrotum, and testicles so they are not visible in clothing. There are many ways to tuck, such as pushing the penis and other anatomy between your legs and then pulling on a pair of undergarments, to tucking the testicles inside of you. People tuck for many different reasons. One might tuck in order to feel more at ease in their body (minimize dysphoria), to feel more comfortable in their clothing, or to facilitate affirmation as one’s gender. There is minimal research on the safety of tucking.

Gaff: compression underwear that minimizes the appearance of a penis, scrotum, and testicles.

Tape: tape may be used with or instead of a gaff to “tuck” or minimize the appearance of the penis, scrotum, and testicles.

Important gaff considerations:

o Choosing the right size gaff is like choosing the right size underwear. One can also measure the circumference of their waist, just above the hips for correct sizing.

o Safe tucking/gaff techniques mirror those of binding:

o Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.

o Minimize duration of wearing, as in reducing the wear time throughout the years. Bottom surgery is an alternate to tucking, however it is important to note that not every individual that tucks will want bottom surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

o Unsafe tucking can affect the circulatory system, musculoskeletal anatomy, fertility issues, sex and intimacy, and skin integrity.

Gaff/ tucking garment maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. Pay special attention to skin folds, folding in the tucking garments (gaffs), bulging skin adjacent to the gaff or selected garment, redness, skin abnormalities, and prolonged indentations. Pay extra attention to the effects of the trans affirming/generally affirming care that you provide.  

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕥𝕦𝕔𝕜𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe tucking practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! Anotha time for the people in the back: we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe tucking practices.

Sources:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.gendergear.ca/pages/all-about-gaffs

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Blog

OT and Transmasculine Equipment: Binders, Packers, and Prostheses Oh My!

Transmasculine equipment or equipment for those with masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals may include: binders, packers, prostheses, and bandaging.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a penis, scrotum, testicles, or other anatomy.

            Packers: A prosthesis with the form a penis

Binders: commercially produced binders designed for binding. Other options (usually less safe options) are sports bra, neoprene/athletic compression garments, plastic wrap, duct tape, and more. The benefits of binding far outweigh the risks, however 𝕥𝕙𝕖 𝕣𝕚𝕤𝕜𝕤 𝕒𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕥𝕒𝕜𝕖𝕟 𝕧𝕖𝕣𝕪 𝕤𝕖𝕣𝕚𝕠𝕦𝕤𝕝𝕪.

Binding: Binding involves wearing tight clothing, bandages, or compression garments to flatten out one’s chest and/or other anatomical features. 

Safe binding practices include:

  • Donning neoprene/athletic compression garments or commercial binders. The limited research supports using neoprene/athletic binders over commercial binders.
  • Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.
  • Minimize duration of wearing, as in reducing the wear time throughout the years. Top surgery is an alternate to binding, however it is important to note that not every individual that binds will want top surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

Binding maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. A binder should never be too tight. Pay special attention to skin folds, folding in binding material, bulging skin adjacent to the binder, redness, and prolonged indentations. Pay extra special attention to the effects of the trans affirming/ generally affirming care that you provide.

According to research, some benefits of binding include:

– Increased self-esteem, confidence, ability to go out safely in public, positive mood

– Decreased suicidality, anxiety, and dysphoria

The research also notes the following risks and contraindications:

– Pain related to the musculoskeletal system and at times internal systems

– Musculoskeletal system changes including bad posturing, shoulder joint ‘popping’, fractures, and muscle atrophy

– Neurological system changes like numbness, dizziness, and more.

– GI system changes, decreased motility, and more

– Respiratory changes like SOB, coughing, and more

– Skin and tissue change like skin breakdown, wounds, and infection

𝕃𝕖𝕥’𝕤 𝕓𝕖 𝕤𝕦𝕡𝕖𝕣 𝕔𝕝𝕖𝕒𝕣

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕓𝕚𝕟𝕕𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe binding practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! I don’t want to hear any of that “we don’t have room in our curriculum for LGBTQIA+ topics” anymore. Sis, honey, darling, we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe binding practices.

Sources and Citations:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.lgbtq-ot.com/terminology

Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19, 64-75. doi:10.1080/13691058.2016.1191675 

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Blog Out in Healthcare

Out in Healthcare: Wade Robinson, OTD

Name: Wade Robinson

Pronouns: He/his

Identity: Gay man 

Background: While completing my undergraduate degree, I became passionate about the field of sexual wellness while working with various non-profit organizations that provided HIV-related services and raised scholarships for LGBTQ students. Those experiences emphasized the importance of education around sexuality, and after beginning graduate school I was delighted to discover that sexual activity is included in the domain of occupational therapy. I was able to bring OT and sexuality education together and collaborate with @sexintimacyOT for my doctoral capstone project to create a continuing education course on LGBTQ0-inclusive practice.

Profession: Occupational Therapy

Area(s) of Practice or Interest: Sexual activity and education, pediatrics, hand/orthopedics

What does being ‘Out in Healthcare’ mean to you?: I believe that generally people have many misconceptions about what it means to be LGBTQ until they know that they know LGBTQ people. In my day-to-day life, I live by the mantra of “advocacy through visibility”, and I try to do the same in a professional setting by being authentic about my own sexual identity. I think this normalizes conversations about sexuality, models to colleagues how to respond, and indicates a safe-space to clients.

What is one thing everyone should know about your identity?: Overall I think that LGBTQ visibility is a good thing, but I’ve noticed that a lot of the mainstream media highlighting LGBTQ people are pretty narrow in their scope. I just want people to check themselves for implicit biases that are easy to subscribe to and know that being gay does not mean being into interior design, subscribing to a particular style of drag, or being into drag at all for that matter. Part of allyship is celebrating LGBTQ people for their identities, so just recognize that there are countless ways for identities to differ and each is as valid as the next.

How do you feel when your identity is included?: We [LGBTQ people] have gone so long without seeing proper representation or inclusion that I definitely notice when we are included in policies and media, even with little things.

What does “taking up space” mean to you?: To me this goes back to the idea of advocacy through visibility. It’s not like I always talk about being gay, queer culture, or anything like that, but I do think it is important to share my sexual identity with the people around me. I think its personal relationships that create allies. It’s so obvious to LGBTQ people how cisnormative/heteronormative everything is by default, and that creates a lot of marginalization that the majority never considers. I think that we can use that lens for the better to recognize how other minority groups could be excluded and erased, then aim for more inclusive, mindful practice.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I know for OT in particular, there are not very many resources, which is why I created the LGBTQ-inclusive course for my capstone project. For healthcare professionals in general, I think the National LGBT Health Education Center is the best resource for practice guidelines. Time in the clinic is precious and the experience is often stressful for clients; it would be very unusual that that time would be best spent with the client educating the clinician about their sexuality. Being educated about sexuality before interacting with clients is best practice. If somebody finds themselves in a situation where they still are unsure, I think the most import thing they could do is approach the situation with humility. 

Has your identity influenced healthcare that you’ve received?: There are two instances that come to mind in which providers made assumptions about me after I disclosed that I am gay, and both instances were regarding sexual health interestingly enough. The first time I was just completing a routine check-up and getting some vaccinations to start graduate school, and the physician suggested that I complete a battery of STD tests. Even after I explained that I have worked in sexual health, am very aware of my relative risks, and was current on all my tests, the physician suggested that I at least get an HIV test. The second time, the nurse told me that they were going to ask me some questions about my sexual health, but once I said that I was gay, they moved on to ask me about other areas of health. Afterwards, without knowing any of my risk factors or sexual habits, they proceeded to try to administer a test that was completely inappropriate and did not apply to me at all. At this point, I said I would not be doing that test, explained that I previously worked in sexual health, and commented that I was surprised that they did not ask more questions to assess which tests were appropriate. The nurse brushed off my response and quickly said that there were more questions on the template but they were optional to ask and this was standard procedure. 

Where can people find you?: Hidden away studying for the NBCOT exam, hiking, or on Instagram at @Wad_the_robin

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Blog Out in Healthcare

Out in Healthcare: Dr. Sakshi Tickoo, BOTh®, Personal Counselor

Name: Dr. Sakshi Tickoo

Pronouns: She/her/hers

Identity: Bisexual

Background: I am 23 year old cisgender female born and raised in Mumbai, India. From being an 8-year-old child interested in gynecology and pursuing Occupational Therapy at the age of 17, a lot has changed unlike my passion for understanding sexuality. When I joined OT all I knew was it enables independence, holistic in approach and has scope for creativity and research. I haven’t been disappointed with that idea ever since I graduated from Asia’s first Occupational Therapy school in 2019. I came out to my family and friends 2 years back. While my parents still believe “bisexuals” don’t exist; my brother, colleagues and friends have been extremely supportive of my choices. However, this relationship with
my own sexuality is ever evolving and I’ve so much to learn about my own body & desires. Currently, I am working as a school-based OT and on the mission of educating and equipping therapists with tools and resources to create and build upon safer, inclusive, and judgement-free spaces for sexual expression.

Profession: Occupational Therapist

Area(s) of Practice: Sexuality and Mental Health, Wellness and
Rehabilitation

What does being ‘Out in Healthcare’ mean to you?: It means to represent and own my authentic self as a person and professional. It allows me to be open, honest with my clients and get a better perspective towards intimacy and relationships. Moreover, it has become a means of creating safer spaces for awareness and sensitizing people on gender and sexuality. This further sets an example of courage for others to be themselves and represent what they believe in.

What is one thing everyone should know about your identity?: Bisexuals are not indecisive, confused, experimenting, or only engaging in polyamory. Sexuality is fluid and sexual expression is a personal choice. Bisexuality for me is having a slightly wider spectrum of choice- an attraction to the person of same or opposite gender. This may also look like attraction to two or more genders for someone else. So, even though it’s one identity, the way we all express it can be vastly different.

How do you feel when your identity is included?: The “B” in LGBTQ is often invisible to most people. Bisexuals aren’t straight enough for the heteronormative society and not gay enough to be included in the LGBTQ+ community. It’s a constant struggle for belongingness but as long as people who matter to me are a part of my life and let me be part of theirs, nothing else matters!

What does “taking up space” mean to you?: Taking up space is an act of resistance. To own and establish your unique brand of self in this beautiful mess of a world. This space has a certain vibe, healthy boundaries, and provides a sense of belongingness. I don’t have to wait to belong anywhere as I belong everywhere. My thought & idea matters. My voice matters. I matter.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Look and create that space of communication about sexuality. It won’t naturally arise because most healthcare workers aren’t addressing this area making patients clueless about the services we could offer. It will be awkward but it’s a skill set we learn and get better at- just like sex! And if it’s too much for you, be open to learn from your patient and let them guide you through this.

Has your identity influenced healthcare that you’ve received?: There is often no acknowledgement or plain ignorance to how I identify. It’s always assumed that I’m a heterosexual because I identify as a cisgender woman. I’ve not been denied any healthcare facilities but most providers fail to understand what I need from them. They lack providing optimal quality care expected from them which makes it harder for me to trust them at times.

Where people can find you:
Website: sexloveandot.in
Instagram/Facebook: @sex.love.andot
Email: sex.love.andot@gmail.com

Categories
Blog Out in Healthcare

Out in Healthcare: Sara Persutti MS, OTR/L

Name: Sara Persutti


Pronouns: They/Them


Identity: Lesbian, Non-binary


Background: I was born and raised in Buffalo, NY. I graduated with my Masters from D’Youville College. I have been practicing for 3 years (currently as a travel OT) and I have worked primarily with traumatized
youth in specialized behavior schools. This is where my passion lies and I plan to become a certified specialist in trauma interventions for youth.
I am lucky to have grown up in a city like Buffalo, where the LGBTQIA+ community is celebrated. I attend local LGBT events, hang out at LGBT bars and cafes, and support local arts and music. I have also modeled for a gender neutral shoot at my hair salon. When I am not being social I enjoy being as active as possible, whether with yoga, lifting, cycling, or hiking. Needless to say, I keep myself busy!


Profession: Occupational Therapist

Area of Practice: Youth-Young adult, School-based


What does being out in healthcare mean to you?: Since I primarily work with youth, coming out as a healthcare worker gives me the opportunity to be an LGBT role model for kids, who are experiencing their own journeys in a world that prioritizes being cisgender and straight. There is a common misguided idea that children are “too young” to be exposed to the concept of being queer, when everything they are exposed to in our current social climate emphasizes heterosexual, patriarchal relationships. Kids who feel they might be trans, gay, etc. have very little representation to identify with, and can be left confused, ashamed, and targeted by their peers. I value that my platform in healthcare allows me to be someone kids can be their authentic selves around, while showing them that being queer is both normal and something they can (and should) celebrate in themselves and others. Destigmatizing queerness in school will help kids feel safer and
more empowered to come to school, perform their occupations, and achieve to their full potential.


What is one thing everyone should know about your identity?: Non-binary lesbians are valid! My gender identity is non-binary, which means I do not identify within the culturally imposed male-female binary. Gender is socially constructed, and I don’t feel compelled to participate in concepts of masculinity and femininity. I’m just Sara! My sexuality is lesbian, which means I am attracted to women and non-binary folk (this frequently misunderstood and sometimes argued, but non-binary people have historically always been included in lesbianism!)


How do you feel when your identity is included?: Even within the LGBT community, non-binary lesbians are often looked at with a sideways head. Even people within the community need to be further educated on inclusivity. When my identity is acknowledged and respected, it feels affirming and great. At work, I have been hesitant to even come out as a lesbian at certain jobs, mostly when it seemed like there weren’t any other queer people around. Once I started encountering openly gay colleagues, I was much more confident to come out. I enjoy feeling empowered to come out on my own terms rather than let people make assumptions and judgments. Fortunately, I’ve never been in a workplace where I felt ostracized after coming out, which has made it easier and more comfortable to be myself while doing my best work.


What does “taking up space” mean to you?: Taking up space means that I feel empowered and safe to be openly and proudly queer. I should be able
to live my truth as fully as my cis and straight peers do, without any shame or disrespect. Unfortunately, LGBT people do still face stigma and discrimination, but the more we take up space and come out, the more we demand that we be considered as equals in healthcare and society as a whole.


What is one piece of advice that I would give to healthcare workers who aren’t sure how to honor the identities of their patients?: The most important thing is learning the needs of each individual patient, rather than relying on generalizations or assumptions. Ask the patient directly what their name and pronouns are so you can always address them and speak about them without invalidating their identity (and never refer to them with labels they have not used themselves). If you are unsure of something related to gender/sexual identity and need to know to help you can work with your patient, ask the patient directly, with open-ended, non-invasive questions (i.e “Are you sexually active? With which genders?”) Never assume that someone performs certain tasks or behaviors because of their identity.


Has your identity influenced healthcare that you have received?: I don’t feel I’ve been discriminated against due to my identity, but I do feel the system needs work in its approach to sexual health in general. All my doctors know that I am a lesbian, and I have been asked if I am with a partner and if I am sexually active. This is usually where the questions end, and I feel patients
would benefit from more in depth questioning. I was once asked about sex toy usage and cleaning, which may have been asked since I am a lesbian, but I would hope practitioners would ask all individuals this question.

Categories
Blog Out in Healthcare

Out in Healthcare: Matt Wild BSN, RN

Name: Matthew Wild


Pronouns: He/him/his


Identity: Gay

Background: I was born and raised in Buffalo, NY. I decided to  enter nursing school because I was always inspired by the compassionate care that nurses provided me throughout my life. 

Profession: Nursing

Area(s) of practice: Mental/Behavioral Health

What does being out in healthcare mean to you?: Being out in healthcare means accepting that you are a role model to those around you. Living my truth is not always easy, but even if it eventually inspires one person to do the same, or feel represented in some way, I’m happy. 

What is one thing you think everyone should know about your specific identity or the LGBTQIA+ community as a whole?: It’s important to never make assumptions about an individual based on your stereotypes of the collective group. Each person is unique in their own way and should be treated so.

How do you feel when your identity is acknowledged and included, in the workplace/ in media OR how do you feel when your identity is not included or acknowledged?: It is amazing to see in my lifetime, the drastic changes that have already occurred in regards to LGBTQIA+ representation in the media and in workplaces. I’m hoping that the ball keeps rolling and that this can be the case for every member of the community.

What does “taking up space” mean to you?: It means living my truth and helping those around me understand better. It means showing clients who come through the clinic doors that this is a safe space, and while we may not get everything right the first time for them, they can count on the fact that we are always evolving for the better

What is one piece of advice that you would give to a healthcare professional that is unsure of how to/inexperienced with honoring and including the identity on someone within the LGBTQIA+ community while receiving healthcare services?: Accepting that you don’t have all of the answers is the first step to a therapeutic relationship with a client in the LGBTQIA+ community. Even for me, my experiences as a gay man may be completely different than those of another gay man. Understanding that a client shouldn’t have to constantly explain their existence and identity to healthcare professionals is also important.


Has your identity influenced healthcare that you’ve received in the past? Absolutely, I remember being asked on a physical if I was “safe when I was privately with girls,” or, “a guy like you must have no problem finding a nice girl.” It’s hard for some people to understand that their assumptions can be really harmful to the mental health of people in the LGBTQIA+ community, and even in some cases deter them from receiving treatment.

Where you can find Matt:

Instagram: @mjameswild

Categories
Blog Travel OT

LSVT and Me

Picture property of https://www.lsvtglobal.com/
Citation

What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

“While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

“Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!

Categories
Blog Out in Healthcare

Out in Healthcare: Molly Sabido PA, PA-C

Name: Molly Sabido


Pronouns: She/her/hers


Identity: Panromantic, asexual spectrum


Background: I was born and raised in Rochester NY where my whole family is from. Growing up I always wanted to be in medicine because I’m passionate about human connection and the human body. As soon as I researched the PA profession I knew it was a perfect fit; it is versatile, allows me a wonderful work/life balance, and provides abundant opportunities to learn and grow every day. I went to PA school at D’Youville College in Buffalo, NY and now I work at a community hospital back home in Rochester. Outside of work I love to draw, hike, sing, and spend as much time as possible with my friends and family.


Profession: Physician Assistant


Area of practice: Hospital medicine

What does being out in healthcare means to you?: I am a person who is proud to display rainbows on my ID badge and my identity in the queer community isn’t something I shy away from, especially at work. I truly believe that love is love, and this openness is something I talk about often and freely. I don’t hold myself back from ignorant people, instead leaning into my queer identity as a tool to educate. I am living proof that kindness and compassion can exist within any body. I have had coworkers thank me for breaking down their own stereotypes about queer folx. I have had patients thank me for creating a safe space to relax and be themselves in an otherwise scary and unfamiliar environment. I am fortunate to be a feminine, straight passing cis woman and I recognize the ease at which I can walk through the world. It is my hope that by gently challenging people’s preconceived notions someday everyone in the queer community will be met with love and acceptance, no matter their identity or outward presentation.


What is one thing everyone should know about your identity?: We ace (asexual) folx don’t get a lot of attention! This is a new area of my identity that I’ve recently been exploring and coming to terms with. Even writing this gives me some anxiety but the more asexuality is talked about, the more normal it becomes, the more people will understand it and maybe even recognize it within themselves. One important thing to know is that asexuality really is a spectrum and people experience it very differently. For me, being asexual and panromantic means I experience romantic attraction to people of all genders, and I very rarely experience sexual attraction (this is where the spectrum comes in). Sex is the least interesting and stimulating part of a relationship; I just don’t get much out of it. I still enjoy physical intimacy, but mostly because it facilitates emotional intimacy. I’m still capable of loving, fulfilling romantic relationships built on solid communication and clear expectations. For a long time I saw my asexuality as something that needed to be fixed or worked through, and it caused a lot of inner turmoil. But I’m finally learning that it is a beautiful part of my identity and something to embrace, not hide from! 

How do you feel when your identity is included?: Historically, the media overwhelmingly acknowledges gay, straight, and bisexual. Lately, it seems like more shows/movies mention pansexuality (Schitts Creek) which is gratifying because it makes me feel really seen and it also makes “pan” a more commonly recognized concept (no, I’m not attracted to skillets or bread). Asexuality however doesn’t get much recognition so my expectations are usually really low when I’m consuming media, and whenever it’s included it’s a lovely little treat. I recently watched a show on Netflix called Sex Education (WATCH IT) and when they had a subplot about an asexual girl I legitimately cried. Generally, I do think we have a lot of work to do in recognizing sexual and romantic attraction are very separate for some people.

What does “taking up space” mean to you?: Simple. This means I can freely be myself in any room I walk into. When I picture myself taking up space I am not minimizing myself. I am proud to be queer regardless of who is in that room with me. Even in situations where people might not understand me, I stay true to myself. I wear that rainbow on my badge and show it off rather that hide.

What is one piece of advice that I would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Most of my coworkers understand and acknowledge my identity because it revolves around who I date. However, some of them still really struggle with understanding trans/non-binary/non-conforming folx and honoring pronouns or addressing sexuality is uncomfortable for them. My advice is this: when it comes to gender identity, a patient’s pronouns aren’t up to you, they are up to the patient. Your job as a healthcare worker is to create safe spaces for patients where they feel comfortable and taken care of, not further isolated by ignorance. Using correct pronouns is an extremely simple way to facilitate a sense of safety and trust. In regards to sexuality, if you aren’t comfortable addressing this topic, then don’t bring it up, just be a kind human and let someone else be a queer ally. If you absolutely have to bring it up because it’s relevant to your job, then do it in a neutral, non-judgmental way please.

Has your identity influenced healthcare that you have received?: Fortunately, no!  

Where you can find Molly:
Instagram: @mollysabidi AND @molly_makes_things

Categories
Blog Out in Healthcare

Out in Healthcare

Hey friends!! I’m so excited to share this new series with you. This is something that I’ve been pondering and working on for a while, and here it is! The Out in Healthcare series!🌈

I wanted to do it right and make sure my intentions are known. I want to increase the visibility of LGBTQIA+ healthcare providers. I want you all to know we ARE taking up space. We may even look just like you do. You may not know our identities, but each one of the interviewees has agreed to visible. We hope that if you’re a student, practitioner, or are even contemplating joining the healthcare field, that you know you’re not alone. We hope that through this series, you will see yourself. We hope that you will see that you can do it to, and that it’s so important for you to take up space and just BE (if it’s safe and you’re ready). I will be featuring healthcare providers from ALL professions. If you know anyone that you think would like to participate, please connect them to me 💖 Get ready to meet the first healthcare hero in this series!

#OutinHealthcare
Categories
Blog Travel OT

Experiences as a Home Health OT in Multiple States

During my travel therapy career, I have worked in California, New York, and am also licensed in/planning to work in Colorado. So far, I have worked in subacute inpatient rehabilitation and home health settings, with more placements in home health at this time.

To be as transparent as possible, my time in home health in California was less than desirable. Not because of the setting itself, but because of the company I was working for. This was my first job after passing the OT board exam. My best friend and long time education partner, Sydney, and I drove from Rochester, NY to San Jose, CA to start travel therapy together.

The company I signed a contract with required me to cover two areas, including but not limited to: Antioch, Orinda, Vacaville, Vallejo, Rio Vista, Concord, Bethel Island, and Oakland. San Jose was a halfway point (or so we thought) for both Sydney and myself to commute to our respective work areas. Sydney was working in school-based pediatric, covering a county. Unbeknownst to the both of us, California traffic is no joke, especially in the Bay Area. I had to commute approximately an hour and a half to two hours to see my first client, and then repeat that for my drive home. I had to see six patients a day, with most of them being evaluations, revisits, and discharges. My orientation consisted of a three day in-class lecture series and no field training. At the time, I had no understanding of the coveted home health point system, from which your productivity is calculated. Thankfully, productivity was never mentioned for me, so I would be safe to assume I was meeting their requirement. We were provided with a bag including wipes, soap, sanitizer, barrier sheets, a laptop, a work cellphone, charging cord, theraband, and theraputty. Though I am thankful for the resources provided, the laptop was cumbersome to carry around and needed to be charged 2-3x per day. As a practitioner that is focused on providing quality, evidence-based, and client-centered therapy, I took most of my documentation home with me. Another part of home health is regularly scheduling patients, calling MDs or related providers, and coordinating with schedulers and office staff. So, with the daily commute to and from the areas, patient care, and documentation, I regularly spent 16-18 hours per day doing work or completing work-related tasks. In retrospect, I was in the perfect environment for burnout and that’s exactly where I landed. I specifically remember breaking down on the phone with my recruiter because I just couldn’t do it anymore. We were able to work a new system out with the OT supervisor due to an opportunity for me to move my area to San Jose. My commute drastically decreased and I was spending 8-12 hours per day on work and work-related tasks, though I was almost always behind on documentation due to a high-level of burnout. I made an effort to battle the burnout with weekly trips to various National Parks and hikes in Northern California, and completed daily documentation outside at parks or near the beach as much as possible. The contract was originally for 13 weeks, and we extended to 16 weeks to take us right up to Christmas time. There was an offer to return after the holidays, but I knew that my time with that company needed to end. Sydney also experienced burnout covering an entire county of under-served pediatric populations and decided to stay at home and not return to travel therapy. I am so thankful for having her with me for that journey, I really don’t know how I would have made it out of their with the little bit of energy that I had left without her.

A year later, I finally encouraged a close friend Sara to jump into the travel therapy world with me. We got lucky with an offer of two contracts with the same company, in the same area of NY. I was resistant to accepting another home health contract due to my previous experience, but I knew it was fair to give the setting another try with a new company. Due to gained experience both as a practitioner and interviewer/interviewee, I was able to determine that this company had an ethical outlook, manageable coverage area, and manageable productivity expectation. With the added bonus of working for the same company, Sara and I jumped on the opportunity and were both offered contracts with the company. Their orientation was a full week, with class time and field time. It was refreshing to have training under an OT preceptor, just to learn the ropes of the tablet and company operations. We were provided with the same protective equipment and bag, a balance pad, cones, a gait belt, a car charger, a tablet (instead of laptop), theraband, and theraputty. I covered one area that consisted of a cluster of 5-6 towns within a 30 minute radius, which seemed rather easy when compared to the 60 minute radius that I covered in California. I worked with a few COTAs in the area who took over a majority of my routine visits. Halfway through the contract, I moved to an area closer to where my partner and I were living and worked with one COTA, Shekera, who is out-of-this-world amazing. I extended my contract to mid-may with the company, though my contract was cut short due to PDGM. I was served a 30-day notice per my contract, and recently ended my contract on March 20th. The caseload was much more manageable, the scheduler and certain patient care managers were incredibly supportive. I was lucky to work with an amazing COTA, and didn’t have much experience with COTA supervision during my time in CA. The change to the Patient Driven Grouping Model (PDGM) did make working in the home health setting in general more difficult. The home health company I signed on with was bought out by a larger home health company shortly before my contract began. The company that shall not be named did continue to seek financial gain and stray from quality patient care in response to PDGM, in my opinion. The frequency of therapy visits was cut, there were conversations regarding cases being OT or PT only, and that OTs/PTs could cover each other’s scopes of practice, and OTRs became evaluation and discharge machines, while COTAs took over most routine visits. Through persistent advocacy and discussion, were were able to get the director to agree to providing the necessary visits per the practitioners discretion in order to meet each individual’s needs.

Pros: I enjoy the home health setting due to the fact that we get to evaluate, assess, and plan to provide interventions in an individuals natural environment. As an OT, what is better than that? I love the creativity that is required to use available resources and collaborate with a client to complete tasks they need to get through each day, with the greatest level of safety and independence. I love the change of environment throughout the day and ability to binge music or podcasts during the commute to each patient.

Cons: Even with a mobile tablet, I found that I continued to take work home with me. I don’t know about you, but when I get home I want to be completely done with work that is required of me. I found that I cannot compromise on maximizing direct client and face to face time during visits, as home health visits are not always lengthy in nature. If you own a car, expect to rack up some serious mileage. Though not an issue in California, hazardous weather can affect productivity and ability to see patients, especially in a state like New York during the winter months. The time spent on technology, whether it was my phone or tablet, was frustrating. In a time of technology, I found it difficult to step away from my phone or tablet and enjoy parts of my day. As someone who is 6’1″, the time in the car and looking at technology throughout the day definitely took a toll on my body.

Overall, I don’t think home health is my happiest place. I am thankful for my experience in the setting. As someone who strives to enter academia in the future, my experiences will allow me to share valuable information and speak on the reality of the setting.

References of OT practice guidelines and COTA Supervision:

California: https://www.bot.ca.gov/forms_pubs/supervision_faqs.shtml

New York: http://www.op.nysed.gov/prof/ot/part76.htm

AOTA:https://www.aota.org/~/media/Corporate/Files/Advocacy/State/Resources/Supervision/MSRSOTA.pdf