What is the role of the patient in occupational therapy?
[Dr. Kristen Maisano] When we're working with service members,
especially those in some of the selective communities,
they're not always forthcoming with information.
So what we need to do in the healthcare setting is create a therapeutic relationship.
They talk about it in school—they teach us how to do it.
But when the rubber meets the road, it's personalities coming together
and meeting that person where they are and not passing judgment
and not saying things like, "Well, you're not in Iraq anymore.
Why are you afraid to drive past a package on the side of the road?
That's not an IED."
Or saying something like, "That's never going to happen here—we're safe here."
From the service member's point of view,
if there's a .001% chance that it's going to happen, it can happen.
And so we need to watch our wording as far as making sure
that we're not downplaying what their thoughts are
but instead meeting them where they are
and then coming up with strategies to be able to conquer some of those problems.
And I like to say in my initial eval
that a service member is the lead in our therapy session. He drives the train.
What I usually do is I do a full evaluation—just a quick battery of questions—
nothing standardized, nothing that can't be developed anywhere.
And it goes through all of our areas of daily living—
all of our instrumental activities of daily living.
Then we look to see at the end of the eval, "So, what do you think you need to work on?
What are your goals?"
One of my patients called it an "OT buffet"
because I kind of lay out what I can do, and they can pick it up and say,
"No, that's not going to work for me—put it aside and try another intervention."
Rehab with TBI and PTSD needs to be service-member directed
because they are very strong-willed individuals and they know what they need.
They know their bodies better than anyone else,
and we just need to be the facilitator of these interventions.
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Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.
Kristen Maisano, OTD is an occupational therapist and the interim director of Rehabilitation Services for the Traumatic Brain Injury Clinic, Fort Belvoir Community Hospital in Virginia. She specializes in evaluating and treating military patients with traumatic brain injuries.
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