On episode 16 of the Arthritis Life Podcast, Occupational Therapists Corinne McLees and Cheryl Crow explore the complexity of the human hand and explain how to best protect tender hand joints when you have arthritis. Corinne also explains how virtual occupational therapy can benefit people with hand pain.
Occupational Therapists Corinne McLees and Cheryl Crow explore the complexity of the human hand and explain how to best protect tender hand joints when you have arthritis. Corinne also explains how virtual occupational therapy can benefit people with hand pain.
Speaker bio:
Corinne McLees is passionate about helping individuals maximize the function of their upper extremities, as she believes the hands are imperative to doing the things we love most. She graduated from VCU’s Master of Science in Occupational Therapy in 2016 and immediately began working in VCU Heath’s hand therapy clinic. Corinne and her OT husband launched My Virtual OT – a 100% virtual occupational therapy practice – in order to safely serve clients amidst COVID-19. She has two small children and one on the way, and she and her husband have greatly enjoyed launching this business together.
Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. She helps others with rheumatoid arthritis determine how to live a full life *despite* arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare she say) FUN patient education and self-management resources.
Medical disclaimer:
All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Links to things discussed in this episode:
- What is Occupational Therapy?
- Homonculus – sensory and motor
- My Virtual OT website
- My Virtual OT Youtube Channel
- Corinne’s Virtual OT Instagram
- Free Handout: Cheryl’s Master Checklist for Managing RA
- Cheryl’s Facebook group: Arthritis Life Podcast, Practical Tips & Positive, Realistic Support
Episode sponsor:
This episode is brought to you by the Rheumatoid Arthritis Roadmap, an intensive online education program Cheryl created to empower people with the tools to confidently manage their social, emotional and physical life with rheumatoid arthritis.
Episode breakdown:
01:00 – Corinne’s explanation of what Occupational Therapy is
05:00 – Educating clients about hand therapy
07:00 – The brain interprets our hands as disproportionately important given their size; discussion of the homonculus
10:00 – How pain affects daily activities
12:42 – Principles of joint protect while living with chronic hand pain
13:00 – How posture alignment awareness protects joints
19:25 – Overuse of exercises, fatigue, and flares
25:05 – How to better understand human behavior to support behavior change
30:15- Corinne explains what happens during a virtual occupational therapy visit for patients with RA
33:00 – The importance of distinguishing between different tyes of pain
41:10 – How support groups can help keep you accountable
45:15- Additional OT treatments: heat and cold, splinting and joint protection
Full episode Transcript:
Cheryl Crow (00:00):
Hi, my name is Cheryl Crow and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years, and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks, to how to respond when people say don’t look sick. Stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness, no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.
Cheryl Crow (00:50):
So, hi, Corinne. Thank you so much for coming on the arthritis life podcast.
Corinne (00:54):
Hi Cheryl. Thank you so much for having me. I’ve been so excited for this. I really enjoy all the content that you get out. Like you’re such a holistic OT and also patient yourself. So it’s been really inspiring to follow you on your journey.
Cheryl Crow (01:08):
Thank you. Oh my gosh. Right back at you. And I just think the timing for you to be, you know, the virtual OT is just so perfect, you know, this year in 2020. So it’s been really great, you know, you’re showing others how much you can get done virtually and how you can really help people in their environment. So let’s take a step back first, actually, you know, can you tell a little bit about, you know, why you became an occupational therapist? A little bit about you?
Corinne (01:32):
Sure. I always knew that I wanted to help people. At first, I wanted to be a psychologist, so I actually studied undergraduate at Virginia Tech in psychology. But through that, I actually learned about OT and one of my courses there. I’d never even heard of what occupational therapy was. At first, I thought maybe it was someone who helps you figure out what your career is or something. But that coincided along with my aunt getting transverse myelitis. She had breast cancer and then she had this transverse myelitis, which is a disorder caused by the inflammation of her spine. And she was actually told she would never walk again. So I was able to witness the power of OT and PT, getting her more independent. She ended up walking again. She uses a cane now. Learning all about OT and all of the fun dressing things that they gave her and ways that she can increase her independence.
Corinne (02:24):
So it was sort of through that experience, as well as learning about occupational therapy in my undergraduate studies, that then I decided I wanted to be an OT. So I picked up a human development double major, and I started getting shadowing hours and taking prerequisite courses for occupational therapy. And then I applied to OT schools. I got into VCU, Virginia Commonwealth University here in Richmond, Virginia, and I transitioned directly from undergraduate to VCU. And that’s a, that was a two and a half year program for your masters. They now do a three-year program for your doctorate, but I was one of the last masters students there. But I did all my shadowing hours in hand therapy and I’ve always been just really drawn to the hands. So I made sure that both my level ones and two field works in school were in hand therapy. And then after that, I landed a job as soon as I graduated in 2016 in the VCU health hand therapy clinic, where I’ve been working as now, I’m a PRN, but I’ve been working there ever since.
Cheryl Crow (03:32):
That’s great. And so that is, is it an outpatient hand therapy clinic? I’m assuming.
Corinne (03:38):
It’s outpatient. Yeah, it is. But because it’s a level one trauma center, we also see a lot of inpatients. And so we’ll take our splint cart up to the hospital and we’ll splint someone who, you know, was burned from head to toe to put their hands in a better position, or we’ll splint someone following, you know tragic motor vehicle accidents. So it’s a great way to see a little bit of everything, but most, mostly it is outpatient.
Cheryl Crow (04:03):
That’s phenomenal. And when you, you mentioned motor vehicle accidents, I remembered that, you know, you see hands hand injuries in all settings and hand conditions. You know, when I did my level two I did one in spinal cord rehab, where of course I saw a lot. And then, but also skilled nursing facility, we had someone come to the facility who would have had a motorcycle accident and he wasn’t wearing, he was wearing a helmet, but he wasn’t wearing gloves. And I was like, well, this should be like an advertisement for why you should always wear gloves. And this was after like months of therapy. But, you know, so I just, yeah, I think that people who don’t have any issues with their hands, you know, we take them for granted like most things, right. You don’t realize how important your little toe is until you stub it. You know, the same with your finger, you get a paper cut and then you’re like, oh my gosh, I use my fingers all the time. So what are, I’m gonna go off script already. Let’s, let’s dive into the hands a little bit. Like what are some of the things that when you educate clients, what are some of the things that maybe are surprising to them about the human hand or yeah?
Corinne (05:12):
That’s a great question. To start with that, I don’t know all of these numbers off the top of my head, so I’ll have to refer to my notes, but one hand alone is comprised of 16 muscles in your forearm, which go into the hand. So your hand has all of the tendons from those muscles. Then you have 17 muscles that actually originate in the hand itself. You’ve got 29 joints within the hand, 129 ligaments, 48 nerves, 27 bones and 30 arteries. That’s just in one hand, that’s not even in both of your hands, just in one hand. And because of all this, if one of those pieces of that system is out of whack, it throws the entire system off. I have, you know, people with fractures that come to me with so many, you know, numbness and tingling and nerve stuff going on, or their artery is disrupted, and they have a lot, or their lymph system is disrupted and they have a lot of swelling. So all of these systems contribute to one another and play a critical role. I’m also really interested in how your brain just plays a wildly disproportionate amount of attention to both the sensation, as well as the motor output in the hands. Like we have 48 nerves in our hands that are constantly sending signals to and from the brain.
Cheryl Crow (06:25):
Yeah. In my rheumatoid arthritis roadmap course, I teach a little bit about the sensory and motor homunculus. [Yes, I was gonna talk about that.] Oh, good. Yeah. Can you tell us a little bit about that? Our hands are so small. Why do they take up so much space in our brain?
Corinne (06:41):
Yeah. Well, I would encourage any listener to actually Google search homunculus. “H O M U N C U L U S.” You’ll find [I’ll put it in the show notes too. Sorry.] Perfect. Okay. So when you look at the homunculus, you’ll find this weird looking person, this weird looking man that has like a really big tongue and large lips, small body, and then like huge hands and like kind of medium-sized feet, but the hands for both the sensory homunculus and motor homunculus are just huge. This is a topographic representation of the sensory and motor distribution of the body found in the brain. So in our brain, we have sort of a representation of our entire body and our hands just take up way more space than they do on our actual bodies. And this is because of all of the nerves and other things that are going on in our hands. They carry way more motor and sensory nerves delivering important messages to and from the brain.
Cheryl Crow (07:44):
Yeah. And you know, when we, I think something that surprised me when I went to occupational therapy school is I knew that there were pathways. Like before I went to OT school, I was a psychology major too. So I was definitely, I wasn’t like a kinesiology or an anatomy major. So that was, you know, a lot of a learning curve for me. But I remember thinking, I knew that like, there was obviously pathways from the brain out to your body to communicate, like, I want to move my arm or I feel X, Y, or Z, but I didn’t realize they were carried separately, like sensory or like feeling. So when we say sensory, we mean like, does it feel hot, cold, tingly? Like the even different kinds of feeling are carried on different pathways and they’re carried different than the motor. Or when we say motor, we mean movement, you know, movement pathways are different. So when you have a chronically painful condition, like arthritis, it’s really helpful to learn at some point, what is pain and what are these pathways, right.
Corinne (08:41):
Exactly. Yes. And our hands really do communicate so much about sensation to our brains. Like you rub your hand on a towel, that feels different than satin. If you’re backward and feel towel versus satin, it wouldn’t feel the same as your hand. And that is sensation. Like you said, temperature, vibration… Pain is a huge pathway. And so because our hands take up so much space in our brain, that’s why we often feel pain, a lot worse in our hands. Like a cut in our hand is different than a cut in our upper arm or something.
Cheryl Crow (09:13):
Totally. And I remember we know when I did a training on pain, they talked a lot about the context matters too. Like if you’re, let’s say you’re in a room and all of a sudden, like a lion enters the room and starts chasing you and you step on a thumbtack as you’re running away, your brain is going to interpret that level of pain differently than if you had just on a normal day been like in a relaxed neurological state. Oh, I’m just walking over to the kitchen, I stepped on a tack. Like your brain is filtering it through what’s meaningful and important in that moment. And survival.
Corinne (09:52):
Yes. Absolutely. Yes, we are such nerds. I love it. I love the hands. To circle back to the motor output that’s required of our hands. Like if we think about what our fingers have to do during the day compared to any other body part, even our toes, even our feet, our fingers do so many different complex things. We type, we button, we put on makeup, or brush our hair, we get dressed, we carry heavy groceries. You know, we hold a cup and somehow bring it to our mouth without spilling it everywhere. And so our hands require all of that, the motor nerves, as well as the sensory nerves.
Cheryl Crow (10:27):
Totally. And you know, my background before doing arthritis, as my focus was in pediatrics and, you know, anyone who has had a baby or watched a baby, or just watched a cute baby video on YouTube knows that it’s a learning process. Your brain has to learn through your movement experiences. It develops like a map of where your body parts are in space, and your body awareness. And, you know, so we, aren’t just born knowing how. We’re not like little deer that get born and then we’re just like able to walk immediately. Right. So we have to experience the world in order to build those pathways. But I think, I guess I would, I’m curious, you know, how does an injury affect that? ‘Cause A lot of times people end up when they have an injury or like a chronically painful condition, then they start not using their hands ’cause they want to protect, but it’s kind of like a balancing act, right. Because if you protect too much, then it’s kinda like you use it, you lose it. Or you don’t use it, you lose it, right?
Corinne (11:25):
Yes, absolutely. Yes. If we’re not using it, like you said, we have to almost relearn how to do certain activities. Sometimes if my patient is right-handed and they injured their left hand, I’m almost more bummed because they’re not going to be using their left hand as much in recovery as they would if they had injured their dominant hand. So I’ll say, make yourself, left-handed, you know, when the fracture is stable or when the condition is stable, we have to practice. And so occupational therapists do a really great job of setting up certain activities or giving them ways to do things over and over and over again, and the same way in different ways. You know, mixing it up and just retraining that motor pathway that is delivering messages to the brain and the sensory pathway so that they can relearn how to do things that are meaningful to them. It’s really not just about, oh, let’s strengthen the hand, oh, let’s make sure that all of our measurements are right and let’s make sure you’re not in pain. It’s it’s like, well, those all matter, but what really matters the most is your function behind all of those things.
Cheryl Crow (12:28):
That’s so beautiful. It’s so OT. Yeah. And you know, you mentioned a little bit about joint protection. What are, you know, because my audience is mostly people with arthritis. What are some things like some principles of joint protection that you think are important? Not just that you think in your personal opinion, but your professional opinion as an occupational therapist.
Corinne (12:50):
Well, I know that you have really done a great job of educating all of your clients in joint protection. And I really I’ve looked to some of your videos, actually. I love some of the videos that you’ve put out about like opening up jars and things in a more protective way. But my, my spiel, I can give you my spiel.
Cheryl Crow (13:09):
I love it. More spiels the better. That’s my motto now.
Corinne (13:13):
So a lot of times people will hear no pain, no gain. But actually in people, you know, in people with rheumatoid arthritis or other chronic or inflammatory conditions, pain really in any condition is a signal that something is wrong. And so ignoring your pain or working through your pain will often increase your pain. My rule of thumb is if you’re experiencing lingering pain, like an hour after doing an activity, then it likely means that you need to change the way that you do that activity or that you participate in that activity. Having good posture is also a great… Yeah, I know I saw that you… So you know, your shoulders down and your your shoulder blades hugging your spine, almost like there’s a pencil in between your shoulder blades. But good posture actually minimizes excessive stress on your ligaments and allows the muscle power to be used to mechanical advantage.
Corinne (14:11):
So for example, when you are rising from a seated position, don’t lean to either side, right? You don’t want to lean to the right or to the left. You want to stay in your plane as you rise from a seated position to lessen the strain on your knees. And it’s allowing your bigger muscles like your quads to do most of the work of standing up. So just practicing good posture and keeping those shoulders down and back hugging that abdomen into your spine is a great practice. Using larger joints, so when you think about the joints in your body, all our hands have so many joints, right? We just talked about everything that’s going on in our hands. Those are really tiny joints. We have to use large joints. We to avoid tight squeezing and pinching and twisting motions that everyday objects often require us to do. They can be especially stressful and painful. So instead, you know, instead of twisting with your fingers on a tight jar lid, if you don’t have an ergonomic jar opener, even just making your elbows straight and putting your palm on the jar lid and then twisting almost from your shoulder that can really help decrease the strain on your tiny little joints. And that allows, again, that muscle power to be really strong behind it.
Cheryl Crow (15:24):
Yeah. And one of the things I love about these strain protection strategies is that they will help you, even if you, maybe your disease is controlled through whatever lifestyle factors or diet or medications you have that are working for you. These are good preventative measures to prevent osteoarthritis in the long run. ‘Cause Even people without an underlying joint condition, a large percentage of the population will develop osteoarthritis in the small joints of the fingers. So if you get in the habit, you know, from a young age of avoiding excessive pressure at some of those more prone joints, like the base of your thumb, you’re going to give yourself a better chance longterm of avoiding additional, you know, osteoarthritis on top of your inflammatory arthritis.
Corinne (16:05):
That’s absolutely such a good point. Ots often come at the patient from a preventative or wellness standpoint as well. So even if we’re only talking about, you know, the arthritis in your right hand, well, let’s, you know, apply it to both hands. Let’s apply this to your whole body because you’re going to benefit from it down the road. Absolutely. I also tell my clients, especially who have arthritis in their knees or their hips, avoid standing in one place. So prolonged static positions can lead to joint stiffness and muscle fatigue. Once your muscles are fatigued, the ligaments take on extra stress, which will then increase your pain. So changing your body positions and gripping postures, taking frequent breaks, and even doing some active motion exercises during seated activities are always to just prevent that static fatigue of our ligaments.
Cheryl Crow (16:58):
That’s really, really helpful. And you mentioned sorry, do you have any more, ’cause I didn’t want to get you off your train of thought, but I had another question.
Corinne (17:04):
I do have three more.
Cheryl Crow (17:07):
Oh my gosh. You are so prepared. I love it. Keep going, keep going. I love this stuff.
Corinne (17:09):
No, two more, two more. So maintaining your strength and range of motion. This is again, just preventative. This is something that we should all be doing, right? Like keeping our muscles well exercised. Stiff joints and weak muscles will be more susceptible to injury. So if we can practice good body mechanics also having larger muscles and just more fluid joints then we won’t be as likely to suffer, for example, a repetitive strain injury or that wear and tear osteoarthritis that you’re talking about. And then the last thing…
Cheryl Crow (17:42):
Can I pause you there actually for a second, because I think this is really, really important and I don’t find a lot of the physics around muscles joints extremely intuitive to me. Like I struggled, I’ll just say in kinesiology, like I had to go in for extra help with my professor and just be like, explain to me again how this works. And so I think I can empathize with some of the patients who it’s hard to understand that basically gravity is, let’s start with the fact that gravity is acting on you at all times, and your body is a physical thing with mass, right? And so these, like you mentioned earlier, all these tiny, tiny muscles, tiny, tiny joints, the way that you choose to grip things and twist things and move things, and the amount of muscle that you have, or don’t have has a huge effect on the actual amount of force that is put into that into each individual joint.
Cheryl Crow (18:38):
And so I think if you can kind of almost like like I think through OT school, I learned how to kind of compartmentalize the fact that my body wasn’t just like this psychological thing. Like it’s my one body that I have. It’s like, oh, it’s the series of like individual little parts for me. But like, so learning that, like this isn’t just like random advice. Like this is actually from the physics of the forces that are working on your body. The second thing I wanted to say is I see so much confusion and I felt it too. I mean around, even if you get it and you understand that, like having more muscle mass around your joints is going to take the strain off of your joint, but there’s so much confusion around exercise because you said on the one hand listen to your pain. [Yes.] And then, but what if it hurts to exercise? So how do you get more muscles without exercise? It’s like very confusing to people.
Corinne (19:34):
Absolutely. And I, you know, I definitely want to talk about like overuse or over-exercising. I see that in clients a lot who just really want to beef up or go through the pain and it’s like, well, no. And that’s, that’s sort of where a skilled therapist comes in too, is to be able to think about, think through your pain, what kind of pain is it? Is it like a muscle fatigue, pain, or is this sort of like a flare up style pain where if we keep going, you’re going to be in pain for the next few weeks. And so it’s super individually dependent as well, but you really touched on my last point of joint protection, which is just to reduce the force and effort that is required of certain activities. So less force and effort means less joint stress, less pain, less fatigue. And so using adaptive equipment, which you do a wonderful job of talking about and educating clients in is a great way to also reduce force and effort as well as practicing good body mechanics.
Cheryl Crow (20:29):
Yeah, and I, you know, I always try to say, like I make the videos to bring attention and awareness to these objects, you know, these life hacks and gadgets and gizmos. But a tool isn’t useful, a tool is only as useful as your use of it. Meaning unless you actually integrate it into your daily routines, it won’t do anything for you. See, I think one of the hardest things is that, you know, if, if I’m sitting there like with a therapist, like with a physical therapist or occupational therapist, a certified hand therapist, and we talk about this, it all makes perfect sense. Like, but then in my real life, I’ve got my kids screaming at me or my dog yapping, and then I’ve got, I’m trying to like answer the phone and it’s been really humbling for me being like both a patient and a provider, because I understand like knowing the information is a crucial first step and it’s egregious to me how that patients aren’t taught all this stuff at the beginning, which is why I formed my educational course.
Cheryl Crow (21:25):
But at the same time, that’s step one, step two is supporting the patient and actually altering their behavior and their habits. And as OTs, we learned about habits, roles, and routines, right. That’s part of our practice framework. So have you had any clients you’ve worked with on that or like like strategies to help people remember it? I mean, certain times, if it’s such a useful tool, you just automatically use it. Like, for example, my key grip while it’s on my keys. [Right. It’s built into it.] Whereas like maybe sometimes for a jar, like the other day I looked at my jar opener, I looked at the jar and I was like, I’m literally too impatient to take the two seconds to use the stupid jar opener, you know, it’s like too Aries human as Socrates said, but I’m just curious if you had any advice for like, you know, the behavior side.
Corinne (22:14):
That’s a really great question. And I wish I had a better answer for you. I feel like [No one knows.] As therapists, we sort of get into this routine of, you know you see your client once a week and they come back to you and they say, well, you know, it’s still hurting here. And it’s like, okay, well, did you do the things that we talked about? No. And then I’ve witnessed not myself, but I’ve witnessed other therapists just sort of like criticizing the patients themselves, you know, like to other therapists or to their patient directly and giving them a hard time for it. And it’s like, well, that kind of tough love is not really giving them understanding of, of their experience or, or helping them through it at all. So, I mean, I think off the top of my head, perhaps, you know, like phone reminders of things that are more of like a time-based thing or, but in the moment, like when you’re talking about the jar opener, I’m not sure.
Cheryl Crow (23:07):
Oh yeah, no, no, no, there’s no silver bullets, but I think the first crucial step is the humility and understanding like, and the empathy and understanding as a clinician that like, you’re not better than someone else just because you know this stuff. You know, how many people out there, clinician or not, know that if you want to lose weight, diet and exercise, diet, and exercise, eat a balanced diet and exercise, we all know it. So it’s not like a lack of knowledge that’s resulting in people not changing their behavior. It’s the fact that behavior change is hard. And then when there are fields that focus solely on that, like I had Kristen on the podcast who does applied behavior analysis,
Corinne (23:47):
Perhaps helpful, or just one way that you can think about the way that your kitchen is set up or the way that the room is set up that has like adaptive equipment. And it is just making sure that it’s easily accessible and visible to your eye as soon as you walk in.
Cheryl Crow (24:00):
That’s huge. Humans are so visual, right. I mean, people who have, who are full sighted, you know, I know not everyone has full vision, but that is totally what I’ve used. Like if I put the jar opener in a drawer, I’m not going to remember to use it even though I’m an OT who like, makes videos about them. If I put it out on the counter near the jars, you know, those little simple behavior hacks are so important. Again, it depends on the severity of how much pain you feel when you do it with, or without the device. If you literally can’t do it without the device, then you will remember. But if you, if it’s kind of a matter of this gray area of like it hurt my hand that bad, badly, but if I use the, if I do it without the device, but then if I use the device, it doesn’t hurt at all I might not remember.
Cheryl Crow (24:48):
So, you know, pain is a good reminder and, you know, for lack of a better phrase. But yeah, the other thing I was going to say about when I talked about really quickly, I referenced Kristin and, and behavior analysis is that, you know, the nice thing about a behavior analysis approach, which very much overlaps with occupational therapists, right, ’cause we do like activity analysis, but the behavior analysis is like looking at your own behavior and then analyzing, what was it that worked for you? So yeah, you mentioned, you know, using phone reminders. That’s a great one. You know, I use that to do like a meditation app, you know, I say, okay, at noon, I’m supposed to be doing this 10 minute meditation. And if I don’t have that reminder on initially, I won’t remember to do it.
Cheryl Crow (25:27):
I mean, eventually I’m hoping it will become a habit, you know, ’cause you kind of start associating times a day with certain things. But for someone else, the phone reminder might not work cause they might just ignore it, like flick it away. So I’ve done that. I’ve done that before too. So you know, we have to kind of problem solve. What is it going to take? And, and I think when it comes to chronic illness, there is this point at which the clinician is not responsible for the patient’s behavior. We can support them. But at the end of the day, the patient has the freedom and to make their own decisions and their own life and they have to slash we have to, as a patient, take responsibility for that and be like the active quote unquote self manager of our own care. And I think that’s a really a paradigm shift for a lot of patients because we grow up sometimes thinking of like healthcare as like a passive thing where I go to the doctor, I used this analogy before, but you know, my ear hurts…
Cheryl Crow (26:23):
I go to the doctor, they diagnose me with an ear infection, they give me the antibiotics, I go home, I feel better. Or like even the idea of PT or OT or massage or something where I go and something is done to me like a therapist stretches my hand or, you know, it’s not, ideally, it’s especially for chronic illness, it’s not gonna serve you to be passive in your care. You have to learn how to be the active manager of your care because you’re the one that’s with you 24 hours a day, you know.
Corinne (26:49):
That’s exactly right. And that actually really reminds me of the proactive versus reactive medical model and how healthcare and big pharma and everything is so reactive. And you know, they make billions of dollars every year on people getting re-injured and then we all react to it versus let’s take a proactive approach and practice these things that are actually going to decrease your pain or decrease your condition severity. And then you won’t necessarily have to have as many visits or, I mean, in chronic illness cases, you still have to be on medicine. But I just feel like it’s definitely a great way to reduce injury. And we also, my husband does, he’s an OT. He does he works with older adults. And so like looking at it from a preventative approach for decreasing your fall risk, that alone is a huge expense, hospitalizations and things like that.
Cheryl Crow (27:43):
Yeah, that totally rings true to me. I mean, to me, it’s like an ounce of prevention is worth a pound of cure, you know, but for some reason, and you would, I’ve had this little soapbox before, but you would think insurance companies would actually want to front-load patients with more preventative and proactive care because then they will cost less money long-term and they can figure that out for certain things like falls. But for other things like, you know, and maybe diabetes likely people who get diagnosed with diabetes, get a ton of patient education and behavior support, because evidence is so strong for like the lifestyle interventions for that. But for some reason, for things like rheumatoid arthritis and you know other inflammatory forms of arthritis and, you know, things like lupus, it’s like, oh, well, whatever, we’ll just wait until they’re, you know, terribly deformed and need a splint and then we’ll deal with it. Like, why is this?
Corinne (28:37):
So frustrating. I absolutely agree with you.
Cheryl Crow (28:40):
One of the special things in occupational therapists, we tend to see things in like a holistic way. So you know, but anyway, yeah.
Cheryl Crow (28:48):
Hi everyone. I’m interrupting really quickly to remind you that this podcast is brought to you by the Rheumatoid Arthritis Roadmap. It’s a comprehensive online education and support program that I created from scratch to help people learn how to live a full life despite rheumatoid arthritis. In the course, you get to learn how to manage everything from physical symptoms, like pain and fatigue, to social and emotional aspects of living with rheumatoid arthritis. I even cover the logistics of things like how to track symptoms and how to advocate for yourself in medical appointments. To learn more, go to myarthritislife.net.
Cheryl Crow (29:27):
A little bit about virtual occupational therapy. Obviously this, you know, before March, I think a lot of people would have said virtual, I don’t want to go to a virtual visit. That might be like, seems like I won’t get as good of care, quote unquote, as in person. Now I think a lot of patients are, I’ve seen at least on social media, a lot of patients are like, this is great. I don’t have to get out of my house. I don’t have to pay for parking. I don’t have to drive the long drive or the long bus ride to get there, the taxi ride, you know. So, but can we, can you paint a little bit of paint me a word picture now of what a virtual OT session might look like for someone with rheumatoid arthritis or similar.
Corinne (30:03):
Yeah, absolutely. I, this has been such a wild ride for us. We never dreamed that we would have opened our own virtual occupational therapy business, but COVID-19 really changed the way that we were all thinking about tele-health and medicine. And I kind of feel like we were all moving in the direction of tele-health and I don’t think that telehealth is going away even after this pandemic goes away. So it’s been really a learning process for me, but yeah, a virtual OT session might look like for someone with rheumatoid arthritis, um if they are not in a flare up, I might text them 20 minutes before and say, hey, don’t forget to put your hand on some heat. I educate my clients and how, if they don’t have a hot pack or a cold pack, how to, well, first of all, when and how to use those and then how to make a hot or cold pack at home using just dry rice and a sock.
Corinne (30:54):
And so I might text them a reminder, hey, you know, make sure that you put heat on if, if they respond well to heat and that can loosen them up for some exercises. And then right, once the session starts, you know, I might assess their pain, see, you know, how their exercises are going, that I’ve taught them in. You know, see if they have any activities that they’re struggling with. I would educate them in any new exercises that they need. And it’s with your hands, which is mostly what I do. It’s very easy to educate on exercises on you know, the platform because in your video, you know, we just hold up our hand and I might have to say, okay, okay, bring your laptop down, down. Okay. Now back up. Okay. I need to see your hand now. So it is a lot more, you know, positioning and communication of the device so that I can see their hand.
Corinne (31:40):
But then, you know, we would go through probably whatever they need, probably, you know, three or four exercises. And I might also, you know, email them the night before and say, hey, make sure that you have a hammer on hand or, you know, a 16 ounce can of soup on hand for your session tomorrow. And so then they would bring that and I would teach them exercises of how to use that within their exercises, like weighted risk curls with a soup can or hammer stretches to increase that supination, that motion of the palm up. We’ve had to think of creative ways to go around exercises. You know, postural correction might be something that we would teach someone with arthritis tendon glide exercises. I don’t know if you’re familiar with those, but just different ways to move your fingers through the full range of motion that is as pain-free as you can.
Corinne (32:33):
And then I also really like my more painful clients to keep a pain log because the most helpful thing that they can do for me is to really like, specify, like what exactly is causing your pain. What’s the time of day, you know, when is the best time of day for you? What are the activities that are causing pain? What kind of pain is it like on a scale of zero to 10? What number is it? Does it, you know, how long does it persist? And so even if they can, they don’t have to keep it every day, but even if they could keep it for every other day, for a week, that would give me a more of a sense of activities that I would then teach them how to modify. And it’s especially working with someone with arthritis. It’s been really honestly easy to do it tele-health. I get a lot of questions of, oh, isn’t OT so hands-on? Well for my clients with arthritis or really painful conditions, I wouldn’t be really doing a lot of manual therapy on them anyway. And most of it really is patient education.
Cheryl Crow (33:32):
That totally makes sense. And you know, I I’ve been getting a lot of my video ideas from just the questions I’ve gotten from other patients online or the questions of the confusions I’ve seen. And one of the most recent ones that I’m working on is just what are the different kinds of pain. Like as again, as a health provider, we got educated to that. Now, actually there is a problem in health education that a lot of people aren’t actually educated in pain science, but we at least get educated that pain is not a uniform thing. There’s not one scale of pain, one to 10, you know, there’s different kinds of pain. There’s stabbing pain, there’s stiffness, there’s soreness, there’s tingling and numbness. There’s, you know, there’s hundreds of words you can use to describe your pain. So even just having that body awareness and that cognitive awareness that oh, pain is not just one thing.
Cheryl Crow (34:24):
So I might have to have maybe four different words that are like the most common pain I have. For example, for me personally, it would be definitely stiffness and like that resistance to movement. That’s one that tends to happen for me in the morning that typical, you know, rheumatoid arthritis pattern in the morning or after periods of inactivity. And then there’s the kind of just general soreness. And then there’s the hot pain, the hot flare pain, which tends to for me, ’cause I have, I’m very pale. You can usually see like pinkness on and literally feel the heat on my knuckles. And this feels like I need to, you know, when I go to the doctor, I might be, if I go to the doctor at 2:00 PM, I might be at a zero on a scale of one to 10 for stiffness, but I might be at a two to three on the scale for hot pain, you know? So what am I supposed to say? If all I’m given is one chart, that’s like one to 10. It’s really hard.
Corinne (35:15):
That’s very true. And what are you also supposed to say, if you are not as self-aware or as body aware as you are, or you haven’t been as in tune with your body? And I feel like I get a lot of clients who are like, it just hurts sometimes. Like maybe here, I don’t know, but maybe also like here and it’s very generalized and I totally get that because I feel like when I go to the doctor, I’m just like, I have all these things I’m going to go say, and then I completely forget it all. And I’m like, I’m fine. Or it’s okay.
Cheryl Crow (35:44):
Oh my gosh. Yes.
Corinne (35:46):
You know, and that’s sort of another point as well, but just, you know, the awareness that you can have of your pain and your symptoms is, is a great way to communicate and to get the most out of your therapy sessions. And I did want to touch more on that, but I also wanted to say that after each occupational therapy virtual session, we follow up our clients with a written home exercise program. And it’s like complete with like pictures, but also like links to videos. And so whatever exercise I, or exercises, I teach my clients, I also make a video, upload it to YouTube and then send it to them so that they can like rewatch it and replay it because if they’re doing things in an incorrect form, then that can cause worst pain. And so when they actually see it on the screen it gives them more of like a better, you know, visual audio queuing that will help them have better form and perform it more often.
Cheryl Crow (36:41):
I think that’s so key. I think that, again, as clinicians we’re already like well-versed in body mechanics, so I can watch you do something and I can remember and retain that because I am trained. Right. And I’m a patient who’s been around for a while in the RA world. But if I was like a newly diagnosed patient and I was watching you do an exercise, I might not understand the difference between like the fingers being close together versus spread out, you know? And it’s funny because this is gonna sound like a weird analogy. I say that like every episode for something, but I used to teach, swing dancing. And that it was really fascinating to me that like how people learn how to move their bodies is really a learning process. And to put it just broadly that like some learners you could, like, I could show them do like right left, right. You know, step, step, hold, and then they would just do it. But the majority of people, they need it to be broken down even further. They need repetition. They can’t remember it the next day. So yeah. Having a video to go back to as like a cognitive cue is super super, and a visual cue is so helpful. So that’s great.
Corinne (37:52):
Yeah. Yeah, absolutely. And in the clinic that I work in, you know, I was guilty of before we started this business, I was guilty of just like using a piece of paper that had been photocopied for 10 years. And just, [Those are good recycling materials] so bad, right. You know, chicken scratching something on there because our productivity standards are so high, you know, you’re just kind of running up the seat of your pants, but then just tossing it to them. And then, you know, wondering why they haven’t done their exercises in the following week. And so we were really trying to think of like creative ways to increase that exercise carry over. Because if you’re seeing your therapist only once a week, even twice a week, what matters the most is like what? That’s like one hour in like however many hours are in a week. So what are, you know, what else are you doing during the week that will enhance that or continue that.
Cheryl Crow (38:42):
Yeah I’ve heard of apps that some places are using, like HIPAA compliant apps where you can like text a reminder to your client, or they can text you like, hey, a picture of me. Here, I did this when I was in, I went to PT with like somebody who specialized in neck and jaw after I got in a car accident where I had not just neck whiplash, but jaw whiplash, which I didn’t know was a thing. [Oh. I didn’t know that was a thing.] Yeah. Yeah. If you’re really lucky you get it. No. But yeah, it really and I don’t know because I already had some TMJ, it just, the force of the whiplash can make your jaw kind of get out of whack and short story, or long story short. So, but you know, I ended up, I just love my physical therapist and I would just on my own and be like, okay, this is my accountability.
Cheryl Crow (39:32):
My accountability action will be, I’ll take a picture of myself doing it, and I’ll just email it to him. But I know there’s people who have apps and I think the apps are really great. And this is why, like, you know, I know some OTs have mixed feelings about other fields kind of encroaching on some of the stuff that we’ve done, but like two fields that come to mind that aren’t as, that don’t involve any, like anywhere near as rigorous of education as OT are like health coaching and life coaching. And the thing I would say about that in terms of behavior change is that, you know, the reason those fields are becoming more popular is that they are intrinsically a health coach and a life coach is approaching this from like a standpoint of I’m just the coach, but you’re the player like you are the one out there that has to make the changes. And I think sometimes it’s like OT and rehab professionals. We sometimes still get stuck in that outdated model where like we’re supposed to do something to them. And instead of like facilitating them, the patient’s doing it. Does that make sense?
Corinne (40:35):
Yes. That makes so much sense and empowering them and educating like why they should be or why they should want to do this.
Cheryl Crow (40:43):
And I mean, there is a line. Like I know that there’s a an OT that I took a class from years ago from Eastern Washington University that studies lifestyle medicine. And, you know, she had a really fascinating talk about it. Lifestyle medicine is all about, is a part of a specialty that doctors can go into. Actually, you can get board certified as a lifestyle medicine doctor. And it’s looking at that prevention, you know, as the foundation of like the triangle of what you’re doing for your interventions. But, you know, she was saying like, it is a a thin line between like you and you need the expert advice to some degree, but at a certain point you might just need like the clinical accountability partner. Like, do you need a masters or a doctorate person every single week to keep you like, you know, compliant with your plan? Maybe not. Not to be like, I don’t love being an OT and everything, but maybe the most efficient model is more like you have to still check in with the most highly trained professional, but then maybe just for those little, like, check-ins along the way you can utilize somebody who maybe is just a, hey, I’m just here as an accountability partner, you know?
Corinne (41:54):
Yeah and I really think that what you said is true about it being like the old way versus the new way, and sort of, I wish that insurance and reimbursement and everything would catch up with the new way, which hopefully one day it will.
Cheryl Crow (42:07):
I know that there are states where people are really trying to get like health coaches and stuff into into the system. The quote unquote the system. What is the system? You know, we always talk about like what is it. So I’m going to try to like summarize a little bit of what we’ve been talking about so far in terms of, okay, what are some of the ways OTs help people with inflammatory arthritis? So you talked about, you know education about the hand. And, you know, how do you protect it and joint protection overall in your daily activities, prevention of future pain, hand strength and specifically like how to strengthen your hands and do exercises like tendon glides, and you know, how to utilize little life hacks and workarounds in your own life, like in the kitchen and to keeping a pain log and understanding your own habits and your own diseases like fluctuations. Is there anything else I’ve missed on ways that OTs help people with inflammatory arthritis or the ways that you help people?
Corinne (43:18):
You’ve done a really great job of capturing our conversation. [I took notes. I cheated.] That’s great. I’m so proud of you. That’s a life hack though.
Corinne (43:27):
So I would say education and modalities that sort of goes along with pain management, right? So you want cold if you’re in that acute flare up and he, if it’s more of like the chronic stiffness or chronic pain, that’s not that hot inflammatory pain. And then hand therapists in particular also really help with splinting. I think in the hand therapy clinic that I have worked at for several years now, splinting is the majority of the emphasis. And I, as a therapist, tried to do more of the holistic everything that we’ve talked about, but I think a lot of the like older model therapists or whatever might just use splinting as like their go-to way to treat someone with rheumatoid arthritis. And that’s not to say splinting isn’t important, because it actually really is, but there’s so many other pieces that go along with it. But to talk about splinting. Resting hand splints are often, I don’t know if you have any splints that you use, but resting hand splints are great overnight.
Cheryl Crow (44:23):
I have a lot but I don’t use the resting ones, but I should, because I’ve noticed, especially recently I gotten into this habit of really flexing my wrist and kind of getting into a not great position at night.
Corinne (44:39):
Yeah. Not the best position for the hand. Yeah. So like fitting them for just a comfortable resting hand splint for when they’re, if they’re in a lot of pain during the day, like just watching TV or resting, but then especially at night, making sure that their hand is in the most functional and resting and comfortable position. We also look at ovulate splints. So if somebody has like is starting to get a deformity in their finger joints where one joint might be bent more than the other or hyperextended, or just unsupported, we would support that with an ovulate splint.
Cheryl Crow (45:12):
Wait is that, do you make that out of thermo-plastic or what do you make that out of?
Corinne (45:16):
So we can. We can do like a custom, like ovulate splint, but we also have like the we have the plastic ones in our clinic, but the silver rings splints are the really nice ones that look like jewelry.
Cheryl Crow (45:26):
I love those. I don’t have them, but I want them. [Like a silver ring splint. They’re actually cute]. Yes, people will ask you if you have them like, ooh, I want one.
Corinne (45:39):
So we can either make one or just put them. Sometimes the ovulate ones don’t work well, like there’s a sizing sometimes there’s just not a right size for them and we’ll try to modify it and it just doesn’t work out. So we can, we can make them ourselves as well. And then just like functional splints, like people with arthritis often have trouble holding their pens or pencils in a correct way. So we will sometimes, like we could make a splint to help them hold their pencil better or make just something out of like the thermoplastic material that can help them.
Cheryl Crow (46:11):
Yeah. I had one for when Charlie was little, I had one that was that stabilized my thumb and that went over the wrist and made out of the thermoplastic. And that helps so much for just all that wear and tear of like lifting. Yeah. And it would remind me, yeah, it reminds me not to overuse your thumb. What about, I know a lot of patients end up buying off the shelf gloves, you know, there’s always different marketed gloves for people with arthritis. You would have the copper gloves and then the… I really love the neoprene gloves that provide that pressure and the thumb C&C one or whatever. [Is that the comfort cool one?] Comfort cool. Yeah. I have a cushion for my tailbone called Comfy Liffe. And then I have the thing for my finger called Comfy Cool. And like I’m just comfy. But I think there’s a lot of like, do you think patients should go to an OT to get guidance on that or is it okay to just get it off the shelf? I get conflicted about this.
Corinne (47:12):
Yeah, that’s true. I think that if they get it off the shelf, yeah, I think it’s important to talk to like somebody like you or their OT or somebody familiar with splints, just because you don’t want them to like waste money on a certain splint. But if they have a good idea, that they need their thumb supported, for example, and they find like a comfort cool, you know, online then there’s no problem. As long as they, I think they usually give you measuring guides, even you can measure like the circumference of your wrist and then give it to them. So I know a lot of people buy off the shelf and I, you know, I have like my favorite splints that I’ll recommend to my clients as well to buy off the shelf.
Cheryl Crow (47:51):
Yeah, no, I can’t believe I didn’t even, that’s so funny. This is so me being like a contrarian OT sometimes where I’m like, I’m not even thinking of the most obvious thing, which is splinting. [Right. You’re like so holistic, which is great though.] But no, I always say like, sorry… It’s my own self-awareness. It’s like, I’m good at doing hard things and sometimes not as good at doing the easy things. Do you know what I mean?
Corinne (48:16):
Right. Yeah, there is a solution that might just reduce pain, like immediately.
Cheryl Crow (48:19):
Yeah, I do try to do a hot and cold just because they do work for me, you know? So and recently I’ll just give a little story. I got these really cute toast shaped hand warmers. I don’t know if you saw my video. And they plug into your USB. I should like become an affiliate for this. Look at how cute these are. They look like little pieces of toast, and then you put them like this and then you can type on the computer.
Corinne (48:51):
I love that. That’s amazing. So it’s like, it’s so functional. You don’t have to rest your hand for 20 or 30 minutes.
Cheryl Crow (48:56):
No, you just keep doing your activities. And the thing about this that I love is that… And what I think a lot of adaptive equipment or pain relief, people don’t seem to think about it, or maybe don’t take into account or maybe they just can’t afford it or something, is the aesthetics and the mental health side of things are important. Like if somebody, especially a young person and a lot of people who have rheumatoid arthritis are, you know, in their thirties, forties, or, you know, twenties… Or juvenile idiopathic arthritis, you know, we don’t want something that looks like ugly or boring, or like only an elderly person is supposed to wear it. No offense to elderly people, but I’m just, this is the vibe I pick up on. Right. And this is one of the reasons I’ve done some of these videos as being like, you know, quote unquote, bringing sexy back to some of these, you know, things like a sock aid, you know, like how can I make this exciting, but you know, putting the aesthetics into account and I will put a quick plug if you guys haven’t listened, or if you all audience haven’t listened to episode one yet, my interview with Sarah Dillingham, she has rheumatoid arthritis or as she calls it rheumatoid disease.
Cheryl Crow (49:58):
And she has developed a wrist brace along with occupational therapists. And she’s trying to develop a more breathable, comfortable, aesthetically pleasing wrist brace or wrist splint. So, you know, I just think that again, as practitioners, sometimes we just, we think so like logically about things like, well, you should just wear this or use this, but if the client and I think, well, I think in pediatrics, we definitely get in this. We definitely understand this, but I think sometimes adult therapists forget that like, if the kid’s not going to use a pencil grip, it doesn’t matter that the pencil grip is going to help them. The same way if someone doesn’t want to use like an ugly splint, it doesn’t matter how helpful that splint could be to them. They have to like actually use it. They have to want to use it.
Corinne (50:39):
Yes, it has to be meaningful and pleasing to them and not too embarrassing.
Cheryl Crow (50:44):
Yeah. Yeah. And I’m surprised sometimes how few options are given. Again, I get the healthcare system is, you know, there’s so many things at play, but I remember when I got my splint made, the only choices of color were like purple, gray and black. And I was like, well, I want purple. You know, I want to be a little bit spunky, but you know, a lot of people it’s like, well, black really stands out. So some people want that. Some don’t and then gray is just kind of like bleh for me, you know. So, you know, but anyway, you know, so I think as OTs, one of the things that separates us from physical therapists is that we’re so highly trained in the mental health side of things, you know? And and I think that that’s often one of my, again, one of my mini mini mini soap boxes is, you know, that we have to look at the mental load of a chronic auto-immune disease that’s fatiguing like rheumatoid arthritis or ankylosing spondylitis, all these forms of inflammatory arthritis.
Cheryl Crow (51:35):
It has a load on your mental health, or it takes a toll. And if we just think about it on the one hand, we need to understand the hands and we need to understand the modalities. So we need to understand joint protection, but it’s equally important to me to give people coping strategies, you know, for how this affects their life, effects, you know, your experience of pregnancy wanting to start a family, dating, relationships, stress, anxiety, depression, like all these things are things we need to be aware of.
Corinne (52:04):
Yes. And if your mental health is in a bad place, that often will then further the cycle of like worst inflammation, worst pain, not using what you need to use or whatever. And then it’s just a cycle of exactly like, you know, I don’t feel good mentally. This is really, really hard on me. This disease is awful. I’m experiencing the worst thing ever. It might feel like that. And then we go into, oh, I’m not gonna, you know, do what I need to do or the stress that the cortisol and all of the stress hormones will then negatively affect your body and cause more pain. And then that furthers your mental health. And so it’s just this awful cycle that we really need to take into account.
Cheryl Crow (52:46):
Yeah. I think there is something you know, about the virtual therapy that in a way it’s, I wonder if it’s more intimate in some ways, because you’re seeing the client in their own home, you know, and you’re kind of able to, maybe the carry over is even better. I’ve heard that’s happening in a lot of settings. People are saying, wow, because I’m able to, like, they can pick up their phone. The client can pick up their phone and they can walk here in their kitchen and say, okay, well, this is how I set up my kitchen and you can… Have you been doing that? That’s great.
Corinne (53:15):
I’ve seen that before. I love, yeah. That’s a huge benefit. It’s just, it’s even more occupation-based and and personal and seeing them in their own roles and habits and routines.
Cheryl Crow (53:25):
Yeah. Well, and I think we’ve actually ended up, I had a couple of other questions written down, but we’ve ended up covering most of them. I wanted to make sure, I always like to ask providers any tips you have for patients to get the most out of their appointments. Like if a patient is going to occupational therapy, either in person or virtually, what are some things that your clients do that you think are really good in terms of… Yeah?
Corinne (53:52):
Yeah. I love that you asked that question. That’s just a really great question. The first thing I thought of that I wrote down, is just to do your homework, which we’ve already sort of already covered. Just the importance of that carry over your home exercises, your modalities, your hot or cold, modifying the activities. You know, keeping those adoptive pieces out where they need to be so that you will use them. And then also like, come with questions. Just personally, I know that if I don’t write a question down before I see a provider, I’m not gonna ask it. And so I need to write questions down, or at least just to have just a solid understanding of what exactly I need to communicate with my provider before I go into it. And then we’ve already also touched on keeping a pain log, but just to give your OT or your doctor a better understanding of the specific activities that cause pain and all those pain specifications that we’ve already talked about, because that will help the provider be a better provider to you.
Cheryl Crow (54:48):
And do you find that a lot of your patients prefer like a good old fashioned pencil and paper log? Or do they prefer the computer or an app?
Corinne (54:57):
Maybe like their phone, like a note on their phone or something, or just a reminder on their phone? I’m more, I’m more of a pen and paper kind of girl. And then you just gotta remember to stick it in your purse when you go, but you’re always going to have your phone on you.
Cheryl Crow (55:09):
Yeah. So I used to be, and I still prefer pen and paper, but of course, if there is a flare up or, you know, hand pain occurring, then I do tend to keep it nowadays, particularly like my running log of things to update my doctor about or doctors for each one, I have a different like note on my phone. And then I also keep it, because I’m always paranoid of accidentally deleting it, I’ll like email it to myself periodically, like, okay, this is what I want to ask the doctor next time. So but yeah, I’m just curious as I know that there’s some great apps out there. Like Arthritis Power is one. I think that Creaky Joints developed and the Arthritis Foundation has an online tracker and we go over all those in the Rheumatoid Arthritis Roadmap program that the end of the day it is just totally about what works for the patient, you know, whatever you’re going to remember.
Corinne (55:56):
That’s awesome.
Cheryl Crow (55:58):
That’s awesome. Yay. Oh, this is so helpful. Is there anything else you wanted to say that I didn’t get to?
Corinne (56:03):
I don’t think so. I feel like we covered all the topics that we wanted to talk about just in our own sort of fluid way.
Cheryl Crow (56:10):
Yeah. No, this is exactly how I love it when it occurs like this ’cause yeah, we went in order, we just talked about certain things earlier than… Yeah. So yeah, this is so great. I really, really appreciate it, you know I can tell that you’ve really developed like a more holistic approach, you know, in your virtual therapy sessions and then while still kind of having one foot in the traditional fields in that… What’s the hospital called that you work at? Virginia, [Virginia Commonwealth University.] Oh okay. Yeah, teaching hospitals are so great, side note.
Corinne (56:46):
Yes. It’s a great way for me to still learn as well.
Cheryl Crow (56:50):
I am like, I’m super loyal to my initial rheumatologist. I’m never gonna move unless she does, but if I wasn’t going to see her at her clinic, I would go to like the teaching hospital, because I think it’s always if you have an option of going to a teaching hospital, you get people who are kind of up to speed, you know, hopefully on the latest and stuff like that.
Corinne (57:09):
Yes, and multiple opinions usually as well.
Cheryl Crow (57:12):
Yes, yes. Which for rheumatology is so key because these are not black and white. Right. So yeah. Awesome. Okay. Well, thank you so much everyone. Where can they find you? I’m going to put all your links in the show notes, but do you want to say it for the auditory learners?
Corinne (57:28):
Our website is www.otvirtual.com and on Facebook and Instagram, we are @myvirtualOT, just the at symbol my virtual OT.
Cheryl Crow (57:39):
Thank you so much. Go check out Corinne @myvirtualOT and I really appreciate your time and sharing your expertise today.
Corinne (57:48):
Thank you so much for having me. I’ve really appreciated our discussion.
Cheryl Crow (58:04):
Thank you so much for listening to another episode of the Arthritis Life podcast. This episode is brought to you by the Rheumatoid Arthritis Roadmap, an online course that I created from scratch to help people live a full life with rheumatoid arthritis. From social and emotional aspects of coping with rheumatoid arthritis, to simple physical strategies you can use every day to manage things like pain and fatigue. You can find out more on my website, myarthritislife.net, where I also have lots of free educational resources, videos, and more.
I’m newly diagnosed and have been having a hard time finding an occupational therapist. Are there OT’s who focus on the lower extremities or is physical therapy the only option?