Physiotherapy Trauma Talks
In Physiotherapy Trauma Talks we discuss the key roles that physiotherapists and other healthcare practitioners play in the management and rehabilitation of patients with traumatic injury. Experts in trauma care offer their insights about in-hospital patient care and post-discharge follow up service delivery. New research in the field of trauma care and rehabilitation is shared to provide answers to your questions.
Physiotherapy Trauma Talks
Trauma Care Through Occupational Therapy with Dr Kirsty van Stormbroek
In this episode we delve into the pivotal role occupational therapists play in trauma care and rehabilitation. Dr van Stormbroek sheds light on how OTs contribute to restoring not just physical function but also the overall quality of life for patients recovering from trauma. Drawing on her wealth of experience, she discusses key strategies for fostering patient participation in their recovery journey, emphasizing that rehabilitation should focus on helping individuals regain their roles in society.
Listeners will hear compelling insights on managing mental health challenges faced by healthcare providers working in high-stress environments. Kirsty addresses the importance of team dynamics among different healthcare professionals and how nurturing effective communication can lead to better outcomes for patients. Tune in, gain valuable perspectives, and join the dialogue on enhancing trauma care for better rehabilitation outcomes.
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Podcast website: https://physiotherapytraumatalks.buzzsprout.com
‘Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach’ published by World Scientific: https://doi.org/10.1142/13509
Hi there, fellow physiotherapists. I am Helene van Asvegen, your host for Physiotherapy Trauma Talks, where we discuss everything related to trauma care. So if you are passionate to learn more about physiotherapy in the field of trauma to ensure that you provide the best possible care for your patients, then this is the right podcast series for you. Today, my guest is Dr Kirstie van Storenbroek, who is a senior lecturer in the Department of Occupational Therapy in the Faculty of Health Sciences at the University of the Werdwatersrand in Johannesburg. Kirstie, thank you so much for joining me today.
Speaker 2:Hi, helene, it's an honour to be here this morning. Thank you for the opportunity.
Speaker 1:You're very welcome, Kirstie. Would you mind just introducing yourself to our listeners in a little bit more detail and explain how you ended up working in trauma care?
Speaker 2:I started my career working in rural and in the community, but then took up a job at Gredeskia hospital and worked in the Martensinger hand unit, where obviously we saw a lot of trauma a lot of hand trauma, but often, you know, polytrauma patients and then I also covered the trauma wards while working at Greteskier Hospital, and so there, yeah, got to love working with patients who had been through traumatic accidents.
Speaker 1:Thank you, kirsty. Yes, greteskier Hospital is a massive public sector hospital in Cape Town, just for our international listeners, and I can imagine that they see quite a huge amount of trauma on a weekly basis. So, based on your experience in that trauma context, what do you feel is the role of the occupational therapist when it comes to trauma care?
Speaker 2:Yeah. So I think, helene, in that acute setting the focus inevitably is on saving life or lung or limb. And I think the occupational therapist's role is to maintain a focus in that acute space to preserve the ability of someone to eventually participate again in daily life and to contribute and be included in society. And so when we're focusing so intently on saving life or saving body structures and functions, we can forget about that and the implications if we do forget about that. So I think that's one of the core contributions of the OT in that team. And I think another key role of the OT is bringing in the patient's participation early in the decision-making. So developing that therapeutic relationship with the client early on, developing that therapeutic relationship with the client early on and, as far as possible, co-authoring a therapeutic process with the client process of healing and rehabilitation that will happen from an early stage and helping to facilitate their insight into the journey that they are likely to walk. And then it's important for the OT to develop an understanding of the patient as an occupational being. And what do I mean by that?
Speaker 2:Occupations are the normal things we do in a day and we need to develop an understanding of what does the patient need to want to and have to do. What are they going back to? Because that informs decisions that we make in those early stages. A very small example a patient that we had who had burns and the surgeons put on a vac dressing on his back and shoulder in a position that was going to compromise his ability to fulfill his role as a painter later on. So the patient needs to be taken back to theatre so that that could be done in a position that actually didn't lead to contractures which would have limited his ability to return to work as a painter, which required full shoulder range of motion. A very small example, but I think the OT is the functional conscience on the trauma team and that's a very important role for us.
Speaker 2:We help with establishing the client's priorities and goals for therapy and we try to facilitate participation and function as early as possible. And the client population that jumps to mind they are your spinal cord injured patients. And the longer someone doesn't participate in basic activities and occupation, the more difficult it is to re-engage, and your mental health security and those kind of things come along with that. So facilitating basic participation in ADLs using assisted devices, so basic feeding and basic self-care with, for example, spinal cord injured patient is important. And then supporting that participation in the acute setting, where often nurses have time restrictions but the OT plays a role in setting up an environment that supports the client in doing those things themselves and developing a sense of efficacy in those tasks.
Speaker 2:I think one of the key key roles of the OTist in that acute phase is preventing the development of physical and psychosocial secondary impairments. So thinking you know your pressure care, your skin breakdown, your joint contractures, your low mood and occupational therapies, contribution is participation and occupation which does wonders for preventing those complications. We want to restore or compensate for impaired body structures and functions at that early stage. We want to restore or modify the patient's functional ability where necessary, so that might be wheelchair provision early on. We want to be very vigilant in screening for psychological sequelae and referring appropriately and then supporting the team in planning towards community reintegration of patients. We can never start too early in terms of planning for that. So I think, yeah, those are the key contributions of the occupational therapist.
Speaker 1:Yeah, that's very interesting to hear, Kirsty.
Speaker 1:So several years ago, when I was still working clinically in the intensive care unit, I had the privilege one day to work with an occupational therapist around the bedside of a patient with a traumatic brain injury, and I remember being so impressed by what my occupational therapy colleague was doing as we were trying to encourage this patient and rehabilitate him towards activities of daily living, from coming out of the sedation and, of course, as a result of some of the effects of the traumatic brain injury on that patient, and I was so surprised to see how the combined treatment actually helped to progress his rehabilitation actually helped to progress his rehabilitation. To me it seemed a little bit faster compared to other patients that we had in the unit. At the same time, just because we made an effort of doing a combined intervention on a daily basis with this patient. And over the years I've noticed that there's sometimes less involvement of occupational therapists in an intensive care unit and I was wondering whether you are able to maybe just talk a little bit about that if you don't mind.
Speaker 2:Sure, helene, and I think, particularly in our public health care system, the main reason for that is not because OTs don't have a role, but because of resources and staffing, and often those acute ICU patients fall a little bit low on the priority list and because of our very high turnover rates patient turnover rates in the hospital the departments are needing to prioritize their pre-discharge patients.
Speaker 2:But that doesn't mean that the OT doesn't have a very active role in the ICU and I agree wholeheartedly that working together and combining our treatment aims is incredibly effective. It prevents us from missing things as well as duplicating services, and I think it also ensures that the mobility gains made by a physiotherapist are then converted into functional gains through the activities that the occupational therapist does. So even with your patients who have low GCS, there's still a role for occupational therapists in terms of sensory stimulation and then, as soon as the patient is fully conscious and ready for graded active rehabilitation, the OT plays a critical role. My experience was mostly in acute spinal cord injury ICU and there one of the main roles is splinting to prevent contractures in the upper limb and to facilitate at that stage early participation in feeding and self-care tasks which, again, I think are very effective if we can time it so that we treat together, and which necessitates a good working relationship between the members of the rehabilitation team.
Speaker 1:Yes, thank you for elaborating on that. Kirsty Wanted to touch a little bit on the role of the occupational therapist versus the social worker versus the psychologist in the management of patients who are recovering from traumatic injury, and if you could maybe just explain how your role differs from those other two professions, that would be great.
Speaker 2:Yes, helene, as you know, the occupational therapists have a very holistic approach to clients and we are trained to assess clients' psychosocial functioning, to assess client psychosocial functioning, and a big part of our assessment or evaluation is assessing the client's environment from which they come in and in which they participate, and so that is why we overlap with the psychologist and the social worker.
Speaker 2:So I think one of the main roles for us is an assessment to screen for difficulties, and the occupational therapist tends to be more commonly part of the team. The services of the social worker and psychologist are less readily available are less readily available. So picking up social and psychological issues is one of the main roles in terms of referral to those services. Within we are also trained to treat, for example, cognitive deficits through cognitive rehabilitation. So there are areas of overlap, but there's obviously a need to remain within our scope and to refer on when that is necessary. Often in our under-resourced settings there aren't psychologists and there aren't social workers and there's a measure of task shifting or sharing, of task shifting or sharing, and often one has to work with the patient to identify resources in their own environment that the client can access in the absence of a full multidisciplinary team that includes a social worker and psychologist.
Speaker 1:Okay, thank you for just making that a little bit more clear, because I think often we don't always understand the nuances of those interactions in the professional team. Just from your experience as a clinical occupational therapist and understanding the role of the different members of the interdisciplinary team, how do you think we can collaborate better together?
Speaker 2:Great question. I think the one thing is to assume a posture of humility, because none of us is all the patient needs is all the patient needs, and because that posture of humility creates then an interdependence on the rest of the team members. Also, it's deciding what the goal, the ultimate goal of our intervention is. If the goal is saving a life, then we don't really need the OT. So it's, working together requires that we articulate what is the focus and the ultimate purpose and goal of our intervention with clients, and I would say it's to, yes, save a life but to enable participation and social inclusion later on. And then suddenly we see the need for all the members of our team.
Speaker 2:And obviously communication is incredibly important. And I think another aspect of working well with the team is effective communication with the patient themselves. I think many of us are familiar with the concept of shared decision making, and bringing the client in as an active member in the decision making process also goes a long way not to just improving patient outcomes but to facilitating better communication in the team. And so I think, if one thinks of a solar system, if we can establish the client as the sun around which our activities and interactions orbit that is going to draw us together, to work well together.
Speaker 1:That's a beautiful analogy. I love that. So thank you for sharing those thoughts, kirsty. When people work in trauma care health providers work in trauma care for months or for years on end how can we become a little bit more aware of how what we are seeing is impacting on our own psyche?
Speaker 2:thank you, helene. This is such important topic and I think in our own particular environment has been largely ignored and just toughening up has been the way to deal with it. But that doesn't necessarily mean that we are able to sustain good care. I think first of all is educating ourselves and creating a culture where these things are essential to talk about. So one of the things that we are at risk of is secondary traumatic stress.
Speaker 2:So witness trauma is still trauma and you don't need to survive trauma to be traumatized by it. You just need to witness it, and that differs from person to person. But you could witness a hijacking and be traumatized by it. You can watch a news story and be traumatized by that. Treating the survivor or the perpetrator of an incident, of a hijacking, for example, can be traumatizing, and listening to the accounts of trauma survivors' experiences can be traumatizing, and at this point this is quite a vulnerable experience to share.
Speaker 2:But having worked for a number of years in trauma care, I developed a fear of knives. I had heard so many stories of stabbing. Interpersonal violence is a very big issue in South Africa and I didn't really understand it. But I developed a fear of knives which I had to deal with and thankfully was able to deal with. Quite simply, another colleague of mine worked in a burns unit early in her career and to this day is unable to light a match without a measure of fear because she experienced the trauma of her patients who had been burnt. So these might seem like somewhat shocking or strange stories, but they demonstrate that being emerged or submerged in a trauma unit exposes you to trauma that can affect your own psyche.
Speaker 1:Yes, definitely.
Speaker 2:And then burnout is maybe a term that we're a little bit more familiar with, which, according to ICF, is a syndrome resulting from chronic workplace stress that hasn't been successfully managed, and it is typically characterized by three dimensions. So emotional exhaustion, or feelings of energy depletion, increased mental distance from one's job, or feelings of negativism or cynicism towards your job, and reduced professional efficacy, and so this is really perhaps something we're a little bit more familiar with, that we need to tend to. And then other factors that can influence our mental health moral distress, when we encounter moral dilemmas in the clinical setting, overexertion, just over a long period of time, working for more intensely than the body was designed to work without rest, which is quite common. And then also perceived support how much support we have in our environment is a big factor that can either be supportive or place us at risk. And then another concept that we need to become aware of is compassion fatigue.
Speaker 2:So compassion fatigue is essentially a combination of aspects of burnout and secondary trauma. It involves psychological, physiological, moral and spiritual damage that can be caused by prolonged exposure to what we might refer to as a toxic environment, and that's really something we need to attend to, not being unaware that we draw a lot of compassion satisfaction from our interactions with our clients, and the beautiful thing is that they're positive spinoffs and they're ways of turning these stresses and exposures into opportunities for growth as healthcare professionals, and I think one of the means to that is growing in our awareness of our risk, and there is a very useful questionnaire called the ProQOL Health Questionnaire that is freely available online and a number of resources that can help us develop our ability to take care of ourselves so that we are better able to sustain effective and quality services in a trauma setting.
Speaker 1:Yes, indeed, and I think physiotherapists, by the very nature of who we are, are often the type of person that would ignore our own feelings and focus on what we can do for the patient, and doing what we do for the patient to the best of our ability, but sometimes to our own detriment regarding our mental health or our emotional well-being. So thank you so much for sharing that information with us, and I'm sure it will help me and the listeners to be a little bit more aware of how we feel and how we interact, and why we interact in a certain way, sometimes just because we are so overly tired or overly taxed with what's been happening and what we are seeing and the emotional burden that you inevitably take on from your patient when you spend time with them in rehab. Kirsty, as we come to the end of our discussion, are there any last thoughts that you maybe want to share with our physiotherapy listeners? Thanks, helene.
Speaker 2:I think perhaps one thing for us all as a trauma team to be thinking about. We equip ourselves to treat and rehabilitate victims of trauma, but are we doing enough to prevent trauma and injury? And that's a whole new discussion, potentially, but it's something that, as a team, we have to look at our contribution to, and one of the, I think, the big ways that we can use our experiences is making the data that we collect available to policymakers to contribute towards prevention and control of injuries specific to our context, towards prevention and control of injuries specific to our context. And then I think it is helpful.
Speaker 2:I have mentioned that we need to constantly reflect on the purpose of our intervention. We get so caught up in the next patient that I have to see and what I have to do. What is it that we're doing? Are we saving a life or a limb or a lung, or are we intentionally working to support a patient to return to participating and contributing to their community? And it's nuanced, but it's very different. They're two different things I think again reflecting on. Are we making our clients central to our decision-making as a team and are we allowing them to articulate a vision for their recovery, whether that's something they feel comfortable or we feel comfortable with. It's something that's essential to patient-centered care and something we need to continually challenge ourselves in.
Speaker 1:Yes, and I think that last bit that you shared, where we have to listen to the patient and to what they want, is so important, because we can often fall into the trap, particularly in the public health care sector, where we have this notion that we know better than the patient what is best for them. Thank you for emphasizing that we need to work as a team to hear the patient and to meet their needs and help them have the best quality of life after the traumatic event. Kirstie, thank you so much. Thanks, helene. It was lovely to chat this morning.
