traveltherapy – The Rainbow OT

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

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!