How OTs Make Daily Routines the Foundation for Wellness

Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the Secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives with the help of a thought leader from the university. MCPHS is 200 years old and what better way to celebrate our bicentennial than with a podcast about longevity and wellbeing? Joining me today is Dr. Douglas Simmons. He is a professor and program director in the School of Occupational Therapy. Welcome. Thank you. Before we dive into our conversation, we're going to start with an icebreaker. So my question for you is, if you had a time machine and could travel 200 years into the future or 200 years into the past, which would you pick and why? I'm going to go with the past, and I'm going to say that because our profession is actually 107 years old, so not quite 200, and I just think it would be absolutely phenomenal to meet the futuristic thinkers that came together one day and said, we need this profession and just understand better as when they started occupational therapy. I just think that would be phenomenal. That leads well into our conversation. And just to start, could you introduce yourself, tell us about your career and how you came to MCPHS. I have spent half of my life growing up in Texas, so I'm actually from Texas and I like that perspective. In my teaching, I kind of have this aspect of a very different geographic than New England. So that was kind of the first half. And then I started out my occupational therapy career at the State University of New York and Buffalo where I went for four years. When I first started my career, OTs got a bachelor's of science. That was the entry point. And then I worked in occupational therapy for about 10 years and then went back for my master's at the University of New Hampshire and then had an experience of being an adjunct in a lab at the University of New Hampshire and realized I really enjoyed teaching. So I went back to Southeastern and Fort Lauderdale, Florida and got my PhD in philosophy, but specifically occupational therapy. And then across my entire clinical career, I have worked in the adult population with individuals dealing with challenges related to neurological such as traumatic brain injury. And I've kind of covered the entire treatment spectrum there, starting an acute care hospital and ending up assisting in the development of a community wellness program in Portsmouth, New Hampshire for these populations. So you've talked a bit about what you've done in occupational therapy, but for listeners who don't know, what is occupational therapy and what kind of patients do occupational therapists. Treat to understand occupational therapy? I think you have to kind of understand their history. So like I said, in 1917, a psychiatrist, an architect, a social worker, a nurse, a vocational work secretary from Canada and a physician kind of came together. So a lot of times people will say OTs do a really huge variety of health related interventions, but a huge part of that is because of our background. We had a lot of disciplines come together and kind of say, I think we need a new discipline. But when they brought their backgrounds into it, it just made our discipline pretty wide and broad. So it was during a timeframe where people were being institutionalized, but they basically sat in chairs and stared at a wall for eight hours a day and then they created this what they called work cure. And basically what they did was they said, people who are busy doing something, creating a role for themself and creating a routine during their day seem to get much healthier than individuals who don't do that. And that we jump into today's world of occupational therapy, we kept those roots and that everything that OT does is around activities that people need to do, whether it's stressing, whether it's driving, whether it's taking care of grandkids or taking care of a pet. So all of our intervention, unlike other disciplines, is the activity that people need to do, want to do or expected to do. And what we do as OTs is we look at the human factor, the physical health of an individual, the mental health of an individual. We look at the environment because most of the time environmental adaptations can enhance performance at a much higher level than trying to change human behavior. And then we also just spend a lot of time looking at the actual activity and breaking that down and determining what physical characteristics are needed, what mental characteristics are needed, and are there steps we can adapt to allow a person to perform this at a much higher level. And we do that across the spectrum. If you go into a public school system, you'll see occupational therapists working with kids and the primary focus there is play. That's what kids do, that's their activity. So you'll see OTs working to kind of develop the motor system, develop the cognitive system, and also work with those kids in figuring out how to take information from the environment and kind of process it in their body to make sense. And kind of the same thing in the adult world, we go from an infant, we can go all the way to the other end of this spectrum. And one of the fastest growing areas in OT is actually home modifications and trying to allow older adults like 90 and older to remain in their home because OTs can assist them in making it safe and allowing them to do what they need to do. So across the spectrum, what would you say makes a good occupational therapy patient? I kind of put that into two categories. The first category is unfortunately with allied healthcare professionals such as occupational therapy, physical therapy, speech language pathologist, we come into people's lives in rather traumatic times. It's they're going to need services after a car accident that has completely changed their personality and their ability to think. So we have kind of that aspect and I would say when we're working with those individuals, they see a future and they see the possibility of being this different person. And when that happens, it creates the motivation for a patient to move forward. For those patients who do not have that vision, it's a difficult road for therapy. And then I think the other side of the spectrum, which occupational therapy is getting more and more involved in, and that's the wellness side, we're really working with individuals to better understand roles and routines and just how to create healthy routines in some fashion that works for their daily schedule or their responsibilities in life and begin to see aspects of improved health and motivation. Can. You talk a little bit more about the wellness aspect of occupational therapy and does it work in tandem with some of the physical movements or does sometimes it take precedence? How is that changing in the field right now? I think what we're seeing most probably in the late sixties, OT kind of really starting to look at this theoretical perspective called flow. Most people have flow state. So a flow state is when you just lose all sense of time and you kind of lose this sense of where you're at in space. And what we now know thanks to neuroscience is that flow state is also associated with many positive chemical reactions in the brain. So that is really pushing OT forward in the wellness world. OT is linking to mindfulness and some of the positive aspects of mindfulness. But again, we do all of that through kind of like an activity based approach. Sure, I'm sure you've heard this, but you can be mindful in washing dishes. So it's still something you have to get done, but you can do it in an aspect to create better wellness in your life. So OT is kind of promoting that and educating individuals around that. Very interesting. We're talking a lot about how OT is very relatively young in the healthcare fields. How have you seen the field evolve because of advancements in technology? And I know the school of occupational therapy here at M-C-P-H-S is really jumping on some of those advancements. It's kind of actually overwhelming at how fast technology is changing. One good example is one of the areas that OT has a lot of involvement with is the veterans administration aspect of war and the trauma of war. And where we see a lot is amputations. And it's just amazing to me that probably 12 years ago, the prosthetics that we gave individuals who no longer had a hand or an extremity to try to function were really archaic. And now they're so incredibly sleek and we're at the point to where they're putting chips into the remaining body part. And instead of having to learn how to move this prosthetic, when a person thinks I want to open my hand, the hand opens. That's. Incredible. It's mind boggling. So what individuals can do is just amazing, but it's very complicated understanding how to use a device and when to use a device. So OT kind of meshes that to make sure the device is right for the person and that they're not going to get frustrated and just never use it again. So it's pretty amazing. And the whole world of virtual reality, which we've kind of began to focus on a lot here at M-C-P-H-S, and we're still learning so much, but what the research really shows us with virtual reality is first of all the motivation factor. We see patients who really were depressed and not wanting to participate in therapy, you put these goggles around their head and you transport them to a different world and their motivation just goes up so high and their aspects of depression are kind of relieved. And again, thinking of that flow state, they get so caught up in what they're doing inside this world, they forget they're in a hospital, they forget they have all these tests that afternoon to see where things are going. So it has just kind of revolutionized what we can do as therapists with our patients. They don't have to be in a hospital room anymore. They can go to Paris and they can go into the Louvre and see the Mona Lisa while they're still at Brigham and Women's in Boston. It's just an amazing aspect. And the other side of that for a therapist, that the technology inside of these virtual reality machines are just making our job so much easier. They keep track of how often the hand has gone above the head, how much stronger a patient may be getting, how long they can actually tolerate an activity. And we see that increase endurance from day to day to day. And our students, we just see as ambassadors, because this is such new technology, they get to spend two full years with it. So when they're going out into clinics, they're kind of leading the way on how to use this and how therapists should be thinking about using it and how best to make differences in our patient's life with using it. So that was going to be my next question is students are learning how to use it now, but has it been adopted in the field yet or what kinds of places are adopting it? I would say any of the kind of research oriented institution like an MGH, those institutions absolutely have adopted and are now part of kind of research efforts and have received funding. And I would say that within the allied healthcare world, that's pretty common because of the grant funding and them putting out the research evidence that we need, the cost of these items usually go down. So more and more and more facilities can then afford those and use those. It seems like the possibilities are almost endless. So what kinds of treatment advancements, whether technological or in another category do you hope are coming for occupational therapists? We're kind of in the beginning trying to understand how this activity of screen time, how that's influencing the levels of stress and anxiety and angst. We're seeing all the way down to second graders now, so I know that the research knowledge that's going to come out around that will have a huge impact in how OTs can kind of change what we're seeing in the school systems and our students here at M-C-P-H-S and try to better tackle how activities and the things you do every day influence your stress and anxiety in either positive or negative ways. We're in a time period now and it's expected to continue for a while where people are just stating they're incredibly lonely and the research is beginning to point to when you're on your devices all day long, you actually lose social skills. You forget how to be social. So I think that'll be another area that OT will be critical in. And then I would say last but not least, but it's coming at us in full force is just ai. How will AI help us in our job as OTs, but then also help our clients? I just think it's going to play a huge role in safe homes and functional homes that people can age in. So I think there's so much possibility there that we're just beginning to look at and tap into. Thanks Doug, so much for this conversation. We've come to the part of our show called Red's Rapid Fire, so I am going to ask you a short series of questions and the goal is to answer them as quickly as possible. Are you ready? I think so. What is your favorite color? Green pancakes or waffles? Pancakes. What was the name of your first pet? Shasta name, A game show that you think you could win. Price is right. What was the last book you read? It's a crime detective called Truth or Dare. If you could have one superpower, what would it be? Ability to read people's minds. Is the glass half empty or half full? Half full. Where is your happy place? The beach. What is your favorite part about working at M-C-P-H-S? My colleagues. And what is one piece of advice you would give to your younger self? Don't spend your days worrying about things you cannot control. Thanks again, Doug. And thank you for listening to this episode of The Secret to Living to 200. We hope you'll join us next time. And as always, stay curious. Cardinals.