Roles Within Roles

As occupational therapists, we often talk about the roles we take on in our daily lives and the occupations that are part of those roles. A parent feeds their child, changes their diaper and transports them to daycare. A dog owner takes them on walks, to the vet and adds their favorite treats to the shopping cart.

But you know what OTPs don’t talk about enough? Roles within roles – how a role changes based on context, the physical environment, those around you – that roles are dynamic and ever-changing. How parent feeds their children may change if one uses a feeding tube. A dog owner who lives in the city may have to remember to bring a leash for every walk, while the only thing a dog owner from the country needs to remember for every walk is to check for ticks afterwards.

It’s important to remember that at any time any role and the occupations associated with it could change – the dog owner in the city could move to the country.

I am an occupational therapist, but right now that is manifesting in three very different ways. Within being an occupational therapist, I am also a business owner and student.  

I’m just finishing up a contract as a school-based therapist. Now, this is what you would expect out of a role of an occupational therapist – treatment plans, note writing, IEP meetings. It’s what I was taught to do and is a fairly textbook, cookie-cutter role.

At the same time, I am continuing work on my private practice. This one is anything but a textbook, cookie-cutter role! Everyday is different and I almost never know what to expect. The occupations as an occupational therapist in this role are extremely different. While I am still treatment planning, note writing and attending client meetings, I am also doing marketing, billing, administration – a lot of which was never taught to us in OT school!

I also started my first semester of my doctoral program this fall. Being a student of occupational therapy, while also being a practicing occupational therapist is the strangest contradiction I have ever experienced. I hope I’m not alone when I say that I really struggled with self-doubt during grad school, so being a student correlates with lack of confidence to me. It’s refreshing to be working in an OT student role now, knowing that I am already the practicing OT I wanted to be in grad school. It helps me take a step back and not cloud my mind with trying to prove myself since I am already proven.

These three roles within my role as an occupational therapist have had me on a rollercoaster of confidence levels for the past couple of months. It’s a whirlwind to go from the confidence of running a private practice to being a student of the same field later that day. But this is one of the aspects that drew me to occupational therapy in the first place – there are so many different directions you can go in, that when you graduate there isn’t this one “thing” you are expected to be or do.

Now it’s your turn – tell me below how a role you take on in life looks different under different circumstances! How do you think we can better address this dynamic in practice?   


Mental Health and Assistive Technology

May is Mental Health Awareness Month!

As the month wraps up, I wanted to start a discussion on the dynamic between assistive technology and mental health. It’s a great opportunity to highlight how assistive technology can work as both a means and an end to support mental health.

What does it mean when something is a means and an end? It means that it is both a way of getting to the end product and the end product itself. In this case, assistive technology can be both a tool in improving mental health and the reason for improved mental health itself.

There’s quite a variety of apps out there that promote better mental health habits and help regulate emotions. Some favorites include:

  • Meditation apps (like Headspace or Calm): Meditation apps are great when trying to redirect challenging behaviors, promote good habits, reframe thinking patterns, or establish a bedtime routine. Personally, Headspace is a lifesaver for those nights my brain just won’t shut off!
  • Mood tracking apps (like Daylio or Moody): When you track your mood daily, it can help you notice patterns, triggers, or positive influences in your life. It’s important to know how your body and mind react to stimuli throughout your day, so you can better prepare for the things that affect your mental health negatively and do more of what makes you feel good!
  • Emotional regulation apps (like iReact): When your feelings are a little too overwhelming, it can affect your functioning. By using apps to regulate your emotions, you can easily identify the feeling, notice how it affects your body and find a productive way to feel your feelings.

This is by no means a comprehensive list of mental health apps, but rather a sampling to let you know what is out there.

Of course, it’s important to note that you can use no-tech or low-tech strategies to accomplish this as well! Simple meditation recordings, color coding your calendar based on your mood and journaling are all really great ways to use no-and-low-tech to work on your mental health.

Now let’s talk about how mental health is an end result of assistive technology use. Assistive technology is designed to improve function, increase independence and promote better quality of life. Simply put – all these things are wonderful for your mental health!

When you get a wheelchair that is properly fitted and comfortable, you have less pain and are able to do more activities due to better positioning, which leads to better mental health.

When you have an accessible and safe home, you can access your kitchen for healthy food and your bathroom to maintain hygiene, which leads to better mental health.

When you have a communication device, you are able to let your needs be heard and socialize with peers, which leads to better mental health.

When you can access a computer for school/work, you are able to participate in learning and earn money independently, which leads to better mental health.

All this is to say – mental health matters and assistive technology can help. If you think you could benefit from an assistive technology evaluation to support your mental health, contact Hamlin Consulting, LLC at 603-460-5958 or lhamlin@hamlin-consulting.com.

Lilly Hamlin and Hamlin Consulting, LLC have no affiliation with any products discussed in this post.

ABCs of OT

I know we are a little behind on this, but April was Occupational Therapy Month!

Every year on Instagram, Shannen Marie (@shannenmarie_ot) hosts an ABCs of OT challenge to advocate for our profession. The idea is that you post an OT word everyday that starts with each letter of the alphabet to educate on all the wonderful things an OT can do. I participated this year on my Instagram (@hamlinconsulting) with an assistive technology twist! I wanted to compile all the posts in one place, so here it is!

A is for Assistive Technology

 Luckily, we get to start off with “A” and define assistive technology right away. From the Assistive Technology Industry Association: “Assistive technology (AT) is any item, piece of equipment, software program, or product system that is used to increase, maintain, or improve the functional capabilities of persons with disabilities.” Personally, I would also extend this definition to include any training, education, strategies and techniques used for the same purposes. AT isn’t always tangible!

B is for Bluetooth

Bluetooth has changed the game for a lot of AT. With wireless connectivity, Bluetooth has increased accessibility and independence for such a wide range of individuals – from physical disabilities to sensory impairments to aging, and even makes life easier for those without disabilities! #UniversalDesign
Here’s some of my favorite Bluetooth AT:
– Blue2 Switch: Gives users single or dual-switch access to mainstream technology while providing auditory, visual, and tactile feedback
– Bluetooth Mouse Simulator: For individuals to utilize a wheelchair joystick to control their computer – we love integrating technology!
-Smartpens are amazing for many students and professionals to organize their notes and receive auditory feedback.

C is for Control Sites
Simply put, control sites are the body sites that can be used to control a device (Cook & Polgar, 2015). This changes based on a person’s physical abilities. Hand and fingers are typically the most preferred control sites, but if these are unavailable the head, upper extremity, feet, knees and even eyes, mouth and chin can be used as control sites! An Occupational Therapists involvement in choosing a control site is so important – we need to measure range of motion, fine motor skills, determine best positioning, consider environmental and social factors, as well as how positioning of AT could influence transfers and ADLs.

D is for Dragon Naturally Speaking
Dragon Naturally Speaking is a comprehensive speech recognition software. Individuals with impairments that limit their ability to manipulate and coordinate typical computer use, can utilize this software to navigate their device with their voice. DNS allows them to dictate documents, send emails, search the web, and use social media. There are several versions of the software for professional, home and mobile use.

E is for Electronic Aid to Daily Living (EADL)
An EADL is a device that allows control of appliances (TV, phone, fan, etc.) through the use of switches (Cook & Polgar, 2015). This allows for those with physical or sensory impairment to access and independently control their environment. This is so important for many reasons – mostly safety. As a lot of us know, there is a pattern of Personal Care Assistant shortages. In this instance, individuals need to be able to independently access the phone, be able to open doors, etc. EADLs also play a huge role in independence, confidence, and self-worth, which are vital for the mental health of our clients. With devices like Alexa and Google Home, EADLs are becoming more mainstream and easier to obtain/use.

F is for Function Allocation
Function allocation is determining which functions of the task will be done by the user, which ones will be done by the AT, and which tasks will be done by a Personal Care Assistant. Why is this important to OT? Well, as Occupational Therapists it is always our goal to keep our clients both as independent as possible and as safe as possible. Putting all task requirements on the AT, would likely be greatly underestimating and devaluing the client. At the same time, AT enables people to continue doing what they love and often does this by increasing the safety of that task. Remember – many conditions fluctuate and change over time, so expect function allocation to also change and use good clinical reasoning!

G is for Guided Access
Guided Access is an Apple feature that allows users to limit access to one app and be in control of available features. Once activated in your settings, all you have to do is press the home button or side button (depending on which model you have!) three times quickly and the guided access feature will pop up. From here, you can limit the device to stay in the current app, block portions of the touch screen, put time limits on the app and device use and much more. This is helpful for a variety of individuals. It helps a lot when using the iPad as a reward as it keeps people engaged and focused on one app with clear expectations. For people with motor impairments, guided access limits the number of accidental activations on a touch screen. I’ve even used it with my 2-year-old nephew when he kept accidentally exiting the game app we were playing while he figured out how to manipulate a touch screen! #UniversalDesign

H is for High Tech
High tech AT is used to describe those fancy, digital, complex AT devices. These are usually more expensive and harder to obtain, but have many more capabilities. They are also harder to use and train individuals on, so even though they are cool, make sure you are using good clinical judgement to match your client to an AT! Examples include power wheelchairs, voice recognition, electronic aids to daily living (remember those from day 5?!)
You can find more information on Georgia Tech Tools for Life website (where they also host a ton of great AT webinars FYI!)

I is for Information and Communication Technology (ICT)
ICT is a term used to describe all communication based technology. This encompasses everything from the internet, cell phones, software, social networking and more! With ICT so mainstream, and a lot of that ICT having built-in accessibility features, it has become much more available and affordable for people with disabilities to use ICT to access and interact with the world. #UniversalDesign

J is for Jouse
No, that’s not a typo and no, I didn’t make it up! Jouse is an assistive technology manufactured by Compusult that allows joystick operation for your computer or AAC device by using your mouth, cheek, chin, or tongue! Remember when we talked about control sites? Well, this is a perfect example of using your face as a control site! This is helpful for a wide range of individuals with very limited motor abilities as it doesn’t require large movements to manipulate.

K is for Kitchen Modifications
One of my favorite areas of AT as an OT is home safety and home modifications. I think that’s because, personally, I have a strong sense of home and attribute a lot of meaning to home and as OTs, we understand the impact the environment has on functioning and wellbeing. The kitchen is one of the most important rooms in a house and is essential for individuals to be able to access for their health. Some ways we can modify the kitchen to make it more accessible and safer are: raising counters to fit wheelchairs underneath, placing visual cues as memory aids for kitchen safety, adding tactile cues to microwave buttons, placing frequently used items lower and within reach and adjusting lighting.

L is for Low Tech
Low tech is cheaper, easy to obtain, sometimes even DIY assistive technology. Now just because it’s cheaper and not as fancy as high tech AT, don’t underestimate its power in making someone’s life easier! Examples of low tech AT include using calendars as a memory aid, using color-coded high lighters, pencil grips, sensory fidgets and so much more.

M is for Monitoring Devices
Controversial AT alert!
Monitoring devices can be the difference between staying at home and having to live in a facility, but it also comes with hefty ethical and autonomy considerations. While the main idea is to promote safety, monitoring devices need to be used in a way that we are still honoring client’s freedom and privacy. Monitoring devices include medication dispensing units, GPS tags, door alarms, video monitoring and smart homes.

N is for Notability
Notability is a great alternative note taking app that lets you utilize highlights, audio and PDF annotation to keep your notes organized! This is a game changer for a variety of students including those with fine motor impairments, executive functioning deficits and auditory learners.

O is for Optical Character Recognition
Optical Character Recognition (OCR) is an AT that has been created mainly to help individuals with vision impairments. This technology translates characters into either speech or Braille output to make the information accessible to those with vision loss.

 P is for Pressure Mapping
Wheelchair users are at an increased risk for pressure sores from prolonged sitting – especially if they don’t have effective pressure relief either independently or through tilt! One way to help identify problem areas and compare wheelchair cushions is through pressure mapping. This is a mat that is placed on top of the seated surface in question, then the person can sit on top and the screen will portray high pressure areas. Seating for comfort is essential for participation in daily occupations and pressure mapping is a great preventative measure!

Q is for Quha
Quha is a manufacturing company for all things computer access! They have a variety of devices for a variety of individuals including contactless puff switch, head mouse, switches, dwell software and more. You can check them out at Quha.com!

R is for Ramps
A ramp may seem like a simple install project, but there is actually quite a bit that goes into it in order for it to be as safe and functional as possible. To meet ADA guidelines, the slope must be no greater than 1:12, have a width of 36 inches and have landings at the top and bottom. While we try to meet ADA guidelines everywhere, they aren’t required in private homes. Adding ramps onto homes poses additional challenges when considering access to garage/driveway, the impact of the weather, emergency exits and aesthetics (it’s important to a lot of clients to have a pretty home!)
Please tell me I’m not the only one who slows down and checks out a ramp when I’m driving!

S is for Screen Readers
Screen readers are a software application that allows users who are visually impaired access technology. They translate text on the screen to either speech or Braille output. The American Foundation for the Blind has a great resource for more information.

T is for Touch Accommodations
Touch accommodations is an Apple feature that allows the user to decide and customize how the touch screen reacts to gestures. For example, you can adjust Hold Duration to customize how long you have to hold a selection before it is inputted. This helps reduce accidental selections for those with tremors and other fine motor impairments.

 U is for Universal Design
Universal design is such an important concept to consider with any environment (physical or virtual), or product. It’s the idea that these things should be accessible to all people without exceptions. My favorite example: a curb cut is helpful to both a wheelchair user and a mother pushing a stroller. It benefits everyone and harms no one!

V is for VoiceOver
VoiceOver is Apple’s screen reader (remember those from day 19?!) It provides auditory descriptions of what’s happening in your screen. It even is compatible with a refreshable Braille display!

W is for Word Prediction
Word prediction is a software that suggests words as the user types and will give guesses as to what the next word will be. The cool thing about word prediction is that it has become fairly universal with mainstream technology! I’m actually using it right now to type out this caption.

X is for X10 Minitimer
The X10 Minitimer is a device that is a timer and home automation system. It controls lights and appliances, turning them on/off at certain times throughout the day.

Y is for Yellow
We are talking low tech today! Yellow (or colors in general, really, but y is hard so give me a break!) can be used to highlight and provide contrast. Highlights are helpful for those with executive dysfunction/learning disabilities to organize information. There are high tech reading programs that provide highlights with text-to-speech to provide visual feedback for sustained attention. Contrasting colors are essential for anyone with a visual impairment as well. You can do this by printing on different colored paper and providing a solid background for activities. AT doesn’t have to be complicated!

Z is for Zoom Magnifiers
Zoom magnifiers enlarge all or part of an object. There are high tech ways to do this for a screen through apps and accessibility settings and low tech ways through magnifiers. It’s a game changer for those with low vision!

Did you learn about any new AT with the ABCs of OT challenge? Tell me below!

If you think you or a loved one could benefit from assistive technology, contact Hamlin Consulting at 603-460-5958 or lhamlin@hamlin-consulting.com.

Lilly Hamlin and Hamlin Consulting, LLC have no affiliation with any products discussed in this post.

What Makes You Bloom?

“When a flower doesn’t bloom, you fix the environment in which it grows, not the flower.” 

– Alexander Den Heijer

That was the quote that was next to my headshot during the slideshow at my graduation ceremony for my master’s degree in occupational therapy (OT). I loved it the second I read it as it so clearly puts into words something that most OT students struggle with – how to define the art and science of occupational therapy. Just like gardening (a valuable occupation within itself!), occupational therapy requires the heart of art and the evidence of science to be successful. Even more, it expresses how we do occupational therapy. The point is never to fix the flower – it’s to provide it with water, soil, and sunshine to help it grow into its most beautiful self. Likewise, it is our jobs as occupational therapists to provide individuals with the tools, resources, and support to grow into their most functional selves.

I discovered fairly early on in my OT journey that one of the best ways to achieve this is through assistive technology (AT). Though, if I’m being honest, my love of AT has seen more ups and downs than a rollercoaster. I’ve always had an interest and took as many AT-focused courses in grad school as I could, but when I got placed in an assistive technology evaluation center for my 3-month Level II fieldwork, I was honestly disappointed. It was my last choice placement and there were so many experiences in so many other settings I wanted more. Little did I know, this was just laying the foundation for my career. That negativity followed me through as I began my fieldwork experience. The content fascinated me, no doubt. Witnessing people try a standing wheelchair and get eye-level with their mom, or independently complete a worksheet at school for the first time, or the look of relief on a caregiver’s face after installation of a lift system is truly magical. We are so privileged as occupational therapists to be able to impact people’s lives in this way! But…it was a hard setting as a student. It wasn’t traditional therapy, a lot of sessions were one-and-dones, documentation was difficult, and there was a lot of travel. It was a relief to be done those 12 weeks.

But, as I finished my last semester of grad school at the University of New Hampshire, I found myself absorbed in an assistive technology for sensory needs class (a Saturday course, no less!). It reminded me, once again, that the love of the content and service provision outweighed the logistical challenges. When I went back to my fieldwork site to gather information for an assignment, the OT that was my supervisor mentioned that they would soon be hiring and I should apply. I may have only said yes for convenience, or for fear of the broader job search, but regardless I did end up accepting the position. After a few rough first months, with struggles similar to those I experience on fieldwork, I found my footing and fell in love with the position. I was put in charge of revamping the computer access program and was fortunate to be given quite a bit of freedom (especially for a new grad!), traveling for home safety assessments and gaining confidence with seating and mobility evaluations. There is such a wide network of team members involved in these services, and I loved connecting with DME providers, school teams, case managers, and families! It really does take a village, and I loved being a villager. 

After about 9 months at this location as my first occupational therapy job, we got the news that the facility was closing. It was a heartbreak not only for us as practitioners, but for the clients we served. Where would they get the same level of assistive technology services? This was a question I was asked many times in the following months as we slowed down business. Often, clients followed with: “Well, can we still see you?” And with that, the seed for Hamlin Consulting, LLC was planted.

It was over a year and half later, though, until I was able to fully dive into it, as life happens sometimes. And that brings us to now. I’m focusing full time on my assistive technology private practice, just passed my ATP exam, and excited to be exploring the AT world again!

So tell me: what makes you bloom?