Despite our best intention, many things in life can feel out of our control, like loss, taxes, divorce, drought, or flood. While we can’t always stop these things happening, we can influence how well we press on in life, and how well we bounce when we hit the bottom. While a lot of public health promotion focusses on controlling our physical health (eat well, exercise), it can be harded to be aware of what is influencing our mental health.

The New Economics Foundation (2010) produced a fantastic review, summarising the everyday things we can do to improve our mental health, namely take notice, connect, be active, keep learning and give. While touted as the “5 a day for mental health”, in truth you don’t need to do all of them everyday to be mentally healthy. However, regularly taking part in these types of activities will help prevent and manage common challenges such as depression, stress, anxiety and burnout (with help from health professionals when things become more difficult).
“Take notice” means taking part in activities that you are totally immersed in. This could be looking at or making art, observing nature, playing sudoku or just reading a good book. “Connect” is about being with others, doing things together, and sharing our lives. “Be active” is about choosing a physical activity that motivates you, whether it’s walking, dancing, swimming, or sports. “Keep learning” can be formal study (e.g., TAFE, U3A for retirees) or simply pushing yourself to learning new things, like new recipes or a ‘how-to’ from Youtube. Finally, “give” is finding ways to help others without expecting anything in return. Examples might be becoming a volunteer or simply mowing your neighbour’s front lawn while doing your own.

We’re very lucky in the Mary Valley to have such a wonderful environment to “take notice” of, and a wide range of enriching opportunities to be active in our community, like volunteering at the Red Cross store, joining Mary Valley Stags or the Kandanga Swim Club. I’d gently encourage you to reflect on how many of the 5 ways to wellbeing that you regularly incorporate in to your life.

Reference: New Economics Foundation (2010). Five ways to well being. Retrieved from: https://neweconomics.org/uploads/files/d80eba95560c09605d_uzm6b1n6a.pdf

The term ‘burnout’ is described as a physical, emotional and mental state of exhaustion that has recently been classified by the World Health Organisation as a clinical syndrome, with the number of cases increasing each year. Warning signs that you may be experiencing burnout out include; disrupted sleep, low or irritable mood, increased heart rate and/or low energy levels. This is the result of a heightened release of our stress hormone, cortisol. Typically, burnout was seen in individuals with high stress related jobs, however, health professionals have identified that anyone is at risk of entering a burnout state. Occupational therapists often consider burnout to be a consequence of occupational imbalance. Occupational balance is often incorrectly seen as an equal distribution of time allocated to work, play, rest and sleep. However, occupational imbalance is often experienced when there is an imbalance between the demands of everyday life and the resources available, e.g., time.

A more accurate way of thinking about occupational balance is the dynamic interaction of three dimensions necessary to achieve occupational balance and wellbeing. The three dimensions include:

1) Have some activities that exceed our skill level offering a challenging experience; 

2) Having some activities that are the ‘just right challenge’, giving as a sense of mastery; and

3) Having some activities that are easy and offer a sense of calm and relaxation to allow for recharge.

There is no quick fix to occupational balance as it is based on the unique experiences of each individual. If you feel you are experiencing the signs of burnout, always check in with your health care provider.

There are so many messages we hear about our health. We’re told to eat well, brush your teeth, exercise, get regular check-ups, limit alcohol intake and avoid cigarettes, just to name a few. It can be easy to lose motivation and fall in to bad habits. For me, it’s extreme Tim Tam consumption. Most people can find at least one health habit we’d like to be easier.

There are more than 60 types of techniques that health professionals use to help people get on track with their health. We’re all different. What works for one person might not work for another. In this month’s column I’ll touch on two techniques you may not have thought much about.

Coping planning. Often, we think about what we want to achieve (goals) and how we’re going to get there (action plan) but forget to plan how we’ll cope if things go wrong. You might have planned to go walking 3 times a week. Then during a week of heavy rain, you think “maybe tomorrow”. By the end of the week you’re out of the habit. If you’ve planned ahead, you’re more likely to stick to your guns; exercising indoors, wearing a raincoat or taking an umbrella. With coping planning, either you or a supportive person prompts you to think about ‘what if’. If you want to reduce your alcohol intake, how do you plan to resist peer pressure if you go out to dinner with friends, or what do you do if you’re given bottles of wine for your birthday.

Being a role model. I frequently find that parents look after their kids’ health a lot better than their own. While it may seem ‘selfless’, the reality is that we (and our kids) do what they see, not what we say. If you’re not motivated to improve your health for your own sake, try thinking about how others will benefit when they see you getting back on track.

These are just two ideas. If you’re finding it hard to fix your lifestyle, find a health professional who you can trust, asks the right questions and helps you navigate supports.

If you’re struggling with your health and looking for a simple starting place, then walking might be for you. It’s free. It’s accessible. You don’t need any fancy equipment, although a pair of well-fitting shoes can help. We even have some amazing places to walk in the Mary Valley like the Amama Walking Trail or the Mary Valley Rail Trail.

When you’re starting out, it’s OK to walk at a speed that’s comfortable for you. Walking improves your physical health¹ and your mental health (especially depression)². Over time, you might aim to increase the speed to “high intensity walking”, which can give you extra benefits. High intensity walking can be broken up into short bouts (e.g., 3 minutes at a time). Overall, you should still aim for the Australian’s physical activity guideline of 150-300 minutes of moderate physical activity per week³.

If you have a complex health condition, you can seek advice from your GP, exercise physiologist or physiotherapist to guide your exercise. Otherwise, it’s healthy and normal to push yourself until you are slightly out of breath. It should be possible, but challenging, to hold a conversation when you are walking that fast.

Walking speed is an important health indicator. In a theatrical, but serious, study of Australian males over 70, a group of researchers set out to find how fast the “Grim Reaper” walks⁴. They looked at peoples’ usual walking speeds and followed participants up over 5 years to look at death rates. They estimated that the “Grim Reaper’s preferred walking speed” is 0.82m/s. The Grim Reaper’s maximal walking speed appeared to be 1.36m/s, so if you’re looking to beat the Grim Reaper, try to keep your usual walking speed that fast or faster. Stretch out your 8m tape measure and see if you can walk that length in 6 seconds or less.

References

¹ Shizue, M., Mayuko, M., & Hiroshi, N. (2019). High-intensity walking time is a key determinant to increase physical fitness and improve health outcomes after interval walking training in middle-aged and older people. Mayo Clinic Proceedings, 94(12), 2415-2426.

² Kelly, P., Williamson, C., Niven, A.G. et al. (2018). Walking on sunshine: scoping review of the evidence for walking in mental health. British Journal of Sports Medicine, 52, 800-806.

³ https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines

⁴ Stanaway, F.F., Blyth, F.M., Le Couteur, D.G., et al. (2011). How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ, 343, d7679.

The silly season (December to January) often means that alcohol flows a little more freely. New Years Day, which for many involves a hangover, is a chance to set a new year’s resolution.

The National Health & Medical Research Council (NHMRC) recently brought out new guidelines for healthy alcohol consumption. The guidelines help Australians make informed decisions to reduce their risk of developing alcohol-related medical conditions. People who follow the guidelines have less than 1 in a 100 chance of dying from an alcohol-related medical condition. The less you drink, the lower the risk.

The guidelines recommend that children and people who are pregnant or breastfeeding should avoid alcohol. For others it is recommended to limit alcohol intake to;

• No more than 10 standard drinks a week and,
• No more than 4 standard drinks on any one day

If you’re struggling with meeting these guidelines, some helpful ideas might be to;

• Have a “dry” day each week or a “dry” month where you don’t drink any alcohol. This can help you to re-evaluate your relationship with alcohol, what triggers or habits you have, and what works for you to break the cycle.
• Talk/chat to someone. This might be a friend, a health professional, or through an App like Daybreak. They can help you figure out a strategy that works for you.
• Get help from a service. The Sunshine Coast Hospital & Health Service (the public system) has an Alcohol & Other Drugs Service (Noosa & Nambour are the closest). DrugArm is in Gympie. We even have Queensland’s largest private addiction rehabilitation facility in our region.

As a health professional and volunteer bartender I see both sides of the picture. Having a few drinks can be part of a fun night. However, the short- and long-term consequences of misuse aren’t as fun. Cheers to healthy choices.

NHMRC guidelines: https://www.nhmrc.gov.au/about-us/news-centre/no-more-10-week-and-4-day

Pain is a common symptom of many medical conditions. We all know what pain feels like. What’s surprising is the pain is a lot more complicated than most people, and many health professionals, think.

Pain happens in the brain. It can occur regardless of whether you have any actual injury or illness. For example, some people with an amputation can experience “phantom limb pain” where they feel pain in a limb that is no longer there. Many people continue to get pain long after an injury has physically healed. The pain is still very real, but we need to use a range of ways to treat it.

If you’ve had pain for more than three months, we know that the brain has already started to change. We call this chronic pain. While there still may be a physical reason for your pain, people with chronic pain have changes in the way that they think and feel. Some of this happens in your brain and spinal cord. Sometimes just having constant pain can get you down, and feeling down makes pain worse. A great Youtube video that can help you to understand the research is “Tame The Beast — It’s time to rethink persistent pain”.

Some signs of a good health professional to help you with your pain are;

• Listens to you and tries their best to understand your experience
• Provides education about pain
• Addresses your pain early on so that it doesn’t become chronic
• Uses more than one method to help you manage pain
• Challenges your thinking about pain
• Supports you to cope with your feelings
• Uses the best available research to choose the right pain treatment or treatments for you, like exercise, ergonomics or psychological therapies
• Puts together a team when you need it (e.g., occupational therapy, physiotherapy, exercise physiology, psychology and/or GP)

The history of healthcare is fascinating. Old practices such as blood letting and leeches are rarely used today. Science and medicine move forward, albeit slowly. If you’re interested in reading about how strongly humans can cling to the beliefs from the past, despite new and clear evidence, I’d encourage you to read about the history of John Snow and the Broad Street Pump. This is a fascinating story, captured in many documentaries, and has nothing to do with the Jon Snow of Game of Thrones fame.

The reason I raise this is that most of you will have been raised with the belief that first aid for sprains and strains is R.I.C.E.; rest, ice, compression and elevation. Most first aid courses still teach this. However, the R.I.C.E. treatment protocol was introduced based on health professionals’ opinions rather than solid research evidence. A review of the evidence for RICE in ankle sprains found “insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults”¹.

While the research continues to evolve, we can be fairly sure that rest is no longer the best treatment, at least for ankle sprains². Complete rest may even be harmful, especially long periods of rest. There is stronger support for light bracing (i.e., protect the joint), early return to light activity (sometimes called ‘optimal loading’) and retraining of ankle stability. Newer acronyms like P.E.A.C.E. (protection, elevation, avoid anti-inflammatories, compression, education) for the first few days after injury, and L.O.V.E. (load, optimism, vascularisation, exercise) for rehabilitation help capture some of the newer evidence³. Further research is needed to test these acronyms. In the meantime, returning to light activities that don’t make the pain worse is a good place to start.

References

1. van den Bekerom, M. et al. (2012). What is the evidence for rest, ice, compression, and elevation in the treatment of ankle sprains in adults. Journal of Athletic Training, 47(4), 435-443.
2. Doherty, C. (2016). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews and meta-analysis. British Journal of Sports Medicine, 51, 113-125.
3. Dubois, B., & Esculier, J-F. (2020). Soft tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 3-5.

The warmer months have well and truly arrived and now is a good time to consider how to take care during Queensland’s hot climate. Our bodies work hard responding to external temperatures to maintain an optimal core temperature of 37^oc to 37.7^oc. This response is called thermoregulation, which is a complex process that activates your sweat glands and blood vessels to reduce the core temperature and protect our vital organs. A rise in your core temperature can result in symptoms such as heat rash, cramps, reduced concentration, nausea and fatigue (to name a few). Occupational therapists often work with clients with physical or neurological conditions that disrupt thermoregulation, resulting in exacerbated symptoms impacting day to day activities. However, multiple factors such as age, body weight, physical ability and medications can disrupt our thermoregulation, placing much of the population at risk. Additionally, people who often work in factories, sheds or outdoors are at risk of heat related illness. Occupational therapists recommend simple strategies that are supported by WorkPlace Guidelines to help mitigate the impact of heat while continuing with your day to day activities;

• Plan ahead: Plan to complete the physically demanding tasks and outings during the cooler parts of the day (typically before 11am and after 3pm).
• Regular breaks: Incorporating regular rest breaks throughout the day will allow your body the opportunity to self-regulate. It is recommended that during this time you find shade and drink water (and plenty of it!).
• Colling Vest: The use of a cooling vest during physical activity can maintain and reduce core temperature. This could be an effective strategy when working around the home or on a jobsite (as pictured).

For more information on ‘working in heat’, refer to the WorkSafe Guidelines at www.worksafe.qld.gov.au. Always contact a health professional if you are experiencing the signs of heat related illnesses.

Toileting habits and health are not a common topic of everyday conversation. It’s something that all of us do, and most of us will experience challenges with toileting at some point in our lives. Toileting is a massive topic, but I thought I cover some things that many people aren’t familiar with.

Toileting is something you can definitely discuss with health professionals. Health professional are used to talking about toileting. If you’re having problems, it can be useful to bring a completed toileting diary (the last 7 days) to your appointment. You might want to take note of when you go and what it’s like (colour, texture, amount). The Bristol Stool Chart is a useful way to describe your faeces (‘poo’). It’s easy to find on Google, with 7 different consistencies. Many things can affect our bowels and bladder, such as illnesses, neurological conditions such as stroke or Parkinson’s, diabetes, medication side-effects and what we eat. Your health professional will have lots of questions to ask you.

Some positions are better for toileting. Squatting is better than sitting for bowel motions (‘poo’). It makes it easier for poo to pass quickly out the body. In Western countries like Australia we are used to sitting on a toilet that is 400mm high. Since we rarely squat in Australia, many of us lose our ability to squat as we get older. One compromise is to lean forward with your elbows on your knees when you do a poo. If you’re tall, a small footstool to lift up your feet can also help.

Incontinence is common. Incontinence is accidents or leakage from your bowel or bladder. About one if five women have bladder incontinence and about one in fifty men¹. About one in twenty Australians have bowel incontinence¹. Your GP or a continence nurse can help find the right treatment for you, and occupational therapists and physiotherapists are often involved. The Continence Foundation of Australia is a great source of information. There are many treatment options like incontinence pads, medications, exercises and toileting regimes that need to be tailored to your condition. The government’s National Public Toilet Map, which is online, can be helpful for some people.

There are more options than scrunch or fold. We are very use to using toilet paper in Western countries. In other countries, people use different ways to clean themselves after using the toilet. For those who have difficulty cleaning properly, such as difficulty reaching to wipe, a bidet is an excellent option. Bidets use a spray or jet of water to clean, rather than paper. Modern bidets can be very sophisticated, using warm water, warm air drying and heated toilet seats. It can be daunting to use a bidet for the first time, but all my clients who have tried them have been amazed by their effectiveness.

Composting toilets and septic system health. Many households in the Mary Valley have a septic system or composting toilet. Sometimes this is out of necessity, but they can also have environmental benefits if waste is managed properly. If you have a septic system, Gympie Regional Council recommends you have your tank pumped at least every 5 years. Poorly maintained septic systems can lead to contamination of our local waterways and make it unsafe for people to use our local creeks for swimming, kayaking, fishing or watering plants or livestock. Composting toilets must be managed carefully. Many websites advise to let you waste compost for a year. Depending on the heat of your compost pile, you may need to leave it longer than a year to compost safely². If you are on regular antibiotics it can also affect your composting toilet or septic system³, and you may need to talk to a health professional about possible solutions.

Accidents, bed-wetting, and fear of using a toilet can be common challenges for kids and their parents. Many children take longer than others to develop their toileting habits. If you’re worried, you can talk to your GP, child health nurse, psychologist or occupational therapist. We’re lucky to have a great occupational therapist on the Sunshine Coast, Di Collis, who specialises in children’s toileting with group programs like Pondering Poos and Wondering Wees, and a free booklet The Adventures of Plopsy the Poo.

References: 1Chiarelli, et al. (2005). Estimating the prevalence of urinary and faecal incontinence in Australia: systematic review. Australasian Journal on Ageing, 24(1), 19-27.

²Nasri, B., Brun, F., & Fouché, O. (2019). Evaluation of the quality and quantity of compost and leachate from household waterless toilets in France. Environmental Science & Pollution Research, 26(3), 2062-2078.

3Kakimoto, T., & Onoda, Y. (2018). Fate of pharmaceuticals in composting process. In: Funamizu N. (eds) Resource-Oriented Agro-sanitation Systems. Springer, Tokyo.

With the limited public transport options in the Mary Valley, many people rely on a car to get around. My first research study in my career explored the process of retiring from driving. Many people talked about driving being part of their identity and providing ‘freedom’. Some people coped better with giving up their licence. Planning, knowing alternatives, and weighing up the pros and cons, all made a difference.

There is no easy answer to when someone should stop driving. There is no age limit for driving, although for those aged over 75, clearance from a doctor to keep driving is required every 13 months. Many older drivers are safe, competent, and experienced drivers. However, the risk of health problems rises with age.

Health problems can affect people of any age. Conditions like epilepsy, diabetes or strokes can affect a person’s ability to drive safely. Jet’s Law was introduced in Queensland in 2008 which requires drivers to declare if they have a medical condition that affects their ability to drive. This law was brought in when a 22-month-old boy “Jet” was killed by a driver who had an epileptic seizure and collided with the family’s car. If you develop a medical condition or an existing condition worsens, it is your legal responsibility to seek advice from your General Practitioner or specialist about whether it is safe to continue driving. This is a complex decision, and your doctor will compare your health and fitness to the Austroads’s Assessing Fitness to Drive guidelines.

When the decision isn’t clear, your doctor may refer you to an Occupational Therapy Driving Assessor for an on-road assessment. Occupational Therapy Driving Assessors have post-graduate qualifications in driving. There are a small number of assessors on the Sunshine Coast. The assessors will make a recommendation to your doctor about your driving safety. They may be able to suggest specific car modifications or training to allow you to continue to drive safely.

The take home message is; if in doubt, you should talk to your health professional (e.g., doctor, optometrist, physiotherapist, occupational therapist). Planning early helps. Make time to have the conversation about warning signs that it might be times to stop driving and how you could live the best life possible if you could no longer drive.

We spend about a third of our life sleeping. Sleep is vital to help repair our body, learn new skills, check and repair memories, manage our mood, and help manage conditions like heart disease and diabetes. People with poor sleep can find it harder to manage their weight. Feeling tired all the time can get us down, but also puts us at greater risk of injury on the road or at work.

Insomnia is difficulty getting to sleep or staying asleep. Many people experience insomnia when their normal sleep is disrupted by a period of stress or illness. Medication (sleeping tablets) is not recommended in the long-term. Other methods such as sleep hygiene and relaxation help more. Stimulus control is the sleep hygiene technique that tends to be most successful. Many nurses, psychologists and occupational therapists can help you learn these techniques.

Another very common problem is obstructive sleep apnoea (OSA), where people stop breathing for short periods during the night. People who are overweight, who snore, or who get a ‘full night’s sleep’ but wake feeling tired are often more at risk of having OSA. Your GP can help you decide if you need to be referred for a sleep study. A machine (CPAP) with a mask that helps keep your airways open is the most common treatment for OSA. A number of people struggle using CPAP and may need to explore other options with a health professional. Other options aren’t always as effective as CPAP, but can help, like sleeping on a wedge, wearing a splint, doing speech pathology exercises or even playing a didgeridoo. Even specific singing exercises can help reduce snoring, which is often a precursor to sleep apnoea.

Other conditions might require more specific interventions. There are a team of people out there, like GPs, sleep technicians and occupational therapists who are there to help.

Back in September 2020, I talked about some of the health-supporting apps available on smartphones. In this month’s column I’ll be exploring the darker sides of smartphone use. Given the relatively recent rise in smartphones, and the fact that it can sometimes takes years to get research published, a lot of the research is relatively new. We’re not always sure what causes what. For example, does excessive smartphone use cause stress, or do people turn to their smartphones when they’re stressed.

There are some clear physical risks of smartphone use. Traffic and pedestrian accidents (e.g., walking into objects and other people) are more likely if people are using their phone. Smartphones can also affect peoples’ hands, shoulders, and spines. In a study of medical students, those who were addicted to their smartphones had higher rates of thumb and wrist pain¹.

There are also psychological risks with smartphone use. Excessive smartphone use is associated with increased stress and anxiety, feeling bad, feeling less in control, being less satisfied with life, and poorer academic performance^2,3. If people are constantly on social media Apps likely Instagram, Facebook or TikTok, they can experience problems with FoMO (‘Fear of Missing Out’). FoMO happens when we see other people being always happy and successful, and start to feel negatively about our own lives. We rarely see the boring, mundane or painful moments of a person’s life on social media, so we can develop a distorted view of the world. ‘Phubbing’ is a new term that describes snubbing the people you are with by being glued to your phone.

We don’t yet know exactly how much is too much when it comes to smartphone use. It will also depend on what you do on the smartphone. If you think that your or your child’s smartphone use may be a problem, consider trying apps like FlipD or AppDetox to help you take back control.

References

1. Baabdullah, A., et al. (2020). The association between smartphone addiction and thumb/wrist pain: A cross sectional study. Medicine, 99(10), e19124.
2. Samaha, M. & Hawi, N.S. (2016). Relationships among smartphone addiction, stress, academic performance, and satisfaction with life. Computers in Human Behavior, 57, 321-325.
3. Horwood, S., & Anglim, J. (2019). Problematic smartphone usage and subjective and psychological well-being. Computers in Human Behavior, 97, 44-50.
4. Wolniewicz, C.A., et al. (2018). Problematic smartphone use and relations with negative affect, fear of missing out, and fear of negative and positive evaluation. Psychiatry Research, 262, 618-623.

Life today is very different from my childhood in the 80s. One of the most wonderful and insidious modern technologies is the smart phone. I use my smart phone every day for things like work, building projects, shopping, navigating, and socialising.

In a future column, I’ll explore some of the dangers of “problematic” smart phone use, but in this column I’ll explore some possible health benefits through apps. While there are a lot of apps out there for all sorts of things (e.g., weight loss, stress management), not every app is equal. Here’s a few examples of apps that might make a difference to your life.

The Hello Sunday Morning initiative was started by Queenslander Chris Raine to help people improve their relationship with alcohol. Hello Sunday Morning has a free app called Daybreak which allows you to connect with others, be guided in problem-solving and receive anonymous health coaching. In a recent study¹, researchers found that people using the app halved their drinking on average and improved their quality of life. Those who got the best results actively participated in the online community, reading and commenting on the posts of others who were on the same journey.

Apps can also help mental health, although no apps currently replace all the functions of a well-trained mental health professional. Some apps are better supported by research. Apps like Breathe2Relax (free), Wysa (free or with a paid therapist), and Virtual HopeBox (free) have many features that can help with managing stress, anxiety and depression^2,3.

For those with kids with autism, the Autism Association of Western Australia has created a great website autismapps.org.au. This site reviews, rates and categorises all sorts of apps to support child development. Areas covered include fine motor, social skills, language and communication, organisation and independence, literacy and numeracy. These apps may also be helpful for children with other conditions. Most apps are free or low cost.

Consider putting your smart phone to good use. Fill it with apps that add to your life and delete the ones that do not.

References

1. Tait, R.J., Castro, R.P., Kirkman, J.J.L., Moore, J.C., & Schaub, M.P. (2019). A digital intervention addressing alcohol use problems (the “Daybreak” program): Quasi-experimental randomized controlled trial. Journal of Medical Internet Research, 21(9), e14967.
2. Bush, N.E., Artmstrong, C.M., Hoyt, T.V. (2019). Smartphone apps for psychological health: A brief state of the science review. Psychological Services, 16(2), 188-195.
3. Wasil, A.R., Venturo-Conerly, K.E>, Shingleton, R.M., & Weisz, J.R. (2019). A review of popular smartphone apps for depression and anxiety: Assessing the inclusion of evidence-based content. Behaviour Research & Therapy, 123, e103498.

Play is one of the most important activities of childhood. It is the way in which children learn about the world and their role in it. Different types of play build different skills that we need for life.

In order to have a full and enriching childhood, children benefit from mixing different types of play. Time spent making mud pies or having paper aeroplane competitions develops hand skills and creativity. Pretending to be pirates or princesses, or pirate princesses, gets children active and helps them practice social skills like friendship, rules and etiquette. If you’ve ever played a game of Monopoly or Risk, you will know how it challenges you to concentrate, stick with a task, and make informed risks.

Children typically adopt different types of play as they develop. For example, one of the earlier forms of play is usually parallel play. In parallel play, children play beside each other (or beside an adult) without interacting. While children usually interact more as they get older, sometimes parallel play is still useful. Think of teenagers putting on makeup or playing computer/smartphone games side-by-side. Just being with someone helps to build connection.

Even as we age, play is still important. Adult playfulness has been associated with improved romantic relationships¹. Playfulness has also been linked with better physical, psychological, and cognitive (thinking) health for older people².

We’re lucky to live in the Mary Valley, where our regional slogan is ‘come out and play’. I’d encourage you to do just that. Mix it up. Play with children, teens, adults and older people. Pretend, create, build, compete, explore, laugh, connect with others, and find time to be alone.

References

1. Proyer, R.T., Brauer, K., Wolf, A., & Chick, G. (2019). Adult playfulness and relationship satisfaction: An APIM analysis of romantic couples. Journal of Research in Personality, 79, 40-48.
2. Walfman-Levi, A., Erez, A.B-H., & Katz, N. (2015). Health aging is reflected in well-being, participation, playfulness, and cognitive-emotional functioning. Health Agin Research, 4(8), 1-7.

I recently finished binge-watching the latest season of a great TV series called Masters of Sex. It’s a dramatized story broadly based on the lives of two very real sex researchers, William Masters and Virginia Johnson. These, and many other sex researchers since the 1930s, shaped a lot about what we know about sex today.

Sex is a normal human drive. Some people are comfortably asexual, which means that they have no or low levels of sexual attraction or desire. For most people however, a healthy sex life is part of a good life. While we don’t often talk about it, sexual dysfunction is very common. There’s so much to talk about, but here’s a few handy concepts.

Remember that there is no ‘normal’ in sex and sexuality. Some people like it occasionally, while some people like it a lot. Some like men, some like women, some like both. Some people really enjoy oral sex, while others are happy to give it a miss. If the people involved are consenting adults, do what works for you. If you or someone you know doesn’t understand consent and sex, Youtube the video “Tea and Consent” by the Thames Valley Police for a simple explanation.

As an occupational therapist, it’s often my job to talk to people when a disability or health condition is affecting their sex life or sexuality. Sometimes it’s about specific strategies, such as different sexual positions that might be more comfortable for certain injuries or health conditions. However, the discussion starts back at intimacy. Health conditions often affect how we feel about ourselves and our body. As stress can make sex more difficult, sometimes it’s good to take the pressure off and just start with touch. Erogenous zones are the parts of the body the make us feel sexual when touched. There’s a great study from Finland (Nummenmaa et al, 2016) where they mapped peoples’ reported erogenous zones. While genitals, breasts and buttocks are common, erogenous zones can be anywhere. Try exploring other zones such as necks, jaws, backs and the inside of the thigh.

If you are having fun with others and are worried that you’ve picked up a sexually transmitted infection, you should talk to your doctor as soon as possible. If you don’t feel comfortable with your normal doctor, Queensland Health has a free and discreet sexual health service called Clinic 87. The clinic even has a day in Gympie Hospital outpatients each week. Where possible, prevention is better than cure.

Reference

Nummenmaa, L., Suvilehto, J.T., Glerean, E., Santtila, P., & Hietanen, J.K. (2016). Topography of human erogenous zones. Archives of Sexual Behaviour, 45, 1207-1216.

Neurodiversity is a modern term which describe the natural differences between people in the way that their brains work. Some of the common ones include being on the Autistic Spectrum or having Attention Deficit Hyperactivity Disorder (ADHD).

Neurodiversity is important for a healthy society. People with autism often have trouble making friends. They often see a lot more detail in the world than others (e.g., the colour of a person’s shirt, or which way a person’s shoelaces are tied) but can miss some of the abstract cues (like body language). While this can make socialising challenging or tiring for people with autism, it often gives them other strengths. Some of the most amazing accountants, workplace health & safety coordinators, and cleaners I know have autistic traits. In these roles, attention to detail is important. I also know many highly creative people with autism, where their autism helps them see the world in different ways to others.

We all know people who are neurodiverse. To make the world a better place, we can work together to give people opportunities to thrive. For a person with autism this might include having consistent routines, providing quiet spaces in homes, schools and restaurants, or taking the time to talk about the special topics the person is really interested in. For people with ADHD keep regular routines and use mobile phone reminders to stay on task, but also provide opportunities to bond over active, stimulating hobbies such as hiking together. Websites like ADHD Australia and Autism Awareness Australia are a great source of information for strategies.

Chronically (more than 3 months) swollen legs and arms are a common problem and can be related to a range of different causes, such as circulation issues or being overweight. It can also result from some treatments. For example, people undergoing breast cancer treatment have around a 20% chance of developing a type of arm (and sometimes breast or chest) swelling called lymphoedema. Many people find that their swelling is a lot worse in the heat of summer. Lymphoedema can occur in any area of the body, but arms and legs are common.

Having just returned from a three-week course exploring best practice in managing lymphoedema, I thought I’d share a few general tips. Firstly, lymphoedema can be managed. It’s not always easy, as you may need lymphoedema therapist-prescribed compression garments to keep your swelling down. How we manage oedema has advanced in leaps and bounds in recent years. The massage techniques have changed from what I learnt years ago, based on studies where fluorescent dyes have been injected into the fingers or toes and massaged to see how and where the swelling moves. The range of garments has also expanded greatly, with better fits, more ways to get the garments on and off, and new looks. Getting in early is a key theme to prevent lymphoedema from becoming more severe.

If you are at risk of lymphoedema (e.g., previous cancer treatment, obesity, previous cellulitis infection) there are ways to reduce the risk. Keep your skin in good condition using an emollient cream daily. Protect your skin, like wearing long sleeves or pants while gardening. Engage in regular exercise and try to manage your weight. Pay attention to possible symptoms such as feelings of tightness, fullness, or heaviness in your limbs and check in with your general practitioner or a lymphoedema therapist if you are concerned.

Experiencing pain and difficulty when opening a jar, using scissors, or turning the door handle? Osteoarthritis is the most common type of arthritis and affects many joints, particularly the thumb. Symptoms can include pain, reduced movement, stiffness and weakness. This can make it hard to do things like cooking a meal, gardening, or sewing. Difficulty doing things that are important to you can affect your quality of life¹.

Osteoarthritis is a degenerative joint disease. It involves breakdown of cartilage surrounding a joint. Cartilage provides a lubricated surface over the ends of our joints to protect them and help them move smoothly. Osteoarthritis can be the result of cartilage changing over time². Osteoarthritis was previously thought to be a result of ‘wear and tear’. Now it is also considered to be a problem with normal healing of cartilage. You can be more likely to get osteoarthritis if you are older, female, have previous joint injury or overuse, weak muscles, obesity, or a genetic disposition¹.

Treating osteoarthritis may involve a combination of exercises, a splint to support your thumb, and equipment to make everyday activities easier. Exercises can help improve your movement and build strength³.Thumb splints can support the joint during heavy activity to reduce pain and prevent stiffness⁴. Equipment, such as lightweight scissors with an assistive spring, can help reduce strain on the affected joint⁵. Changing how your do everyday tasks can also help to reduce pain and fatigue, and improving or maintain function of thumb⁶.

If you are concerned that you are experiencing symptoms of osteoarthritis or want to explore ways to reduce the onset, contact your local occupational therapist or physiotherapist with skills in hand therapy.

References

1. Hunter, D., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet (British Edition), 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9
2. Kheir, E., & Shaw, D. (2009). Hyaline articular cartilage. Orthopaedics and Trauma, 23(6), 450–455. https://doi.org/10.1016/j.mporth.2009.01.003
3. Kjeken, I. (2011). Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis. Scandinavian journal of occupational therapy, 18(4), 265-281. https://doi.org/10.3109/11038128.2010.514942
4. Egan, M., & Brousseau, L. (2007). Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence. The American Journal of Occupational Therapy, 61(1), 70–78. https://doi.org/10.5014/ajot.61.1.70
5. Kjeken, I., Eide, R., Klokkeide, Å., Matre, K., Olsen, M., Mowinckel, P., Andreassen, Ø., Darre, S., & Nossum, R. (2016). Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial. BMC Musculoskeletal Disorders, 17(1), 473–473. https://doi.org/10.1186/s12891-016-1321-3
6. Radomski, M., & Latham, C. (2014). Occupational therapy for physical dysfunction (Seventh edition.). Wolters Kluwer Health.

“Nothing is at last sacred but the integrity of your own mind.”

                                                       ~ Ralph Waldo Emerson

When Emerson wrote this line he was likely talking about strength of will and character, however the quote brings focus on how important the mind is to being human. Aristotle wrote about the active mind being the essence of life. The mind is our way of experiencing the world and is shapes our identity.

It’s no wonder that issues like dementia (where people have difficulty with thinking and memory) are often ignored, overlooked, or spoken of quietly. Thinking can be affected by many things, such as stress, drugs and medications, emotions, and age. Some changes to thinking are normal as we age (but not inevitable) such as slowed physical reactions, taking longer to thing, and being a little less flexible in our thinking. When these changes noticeably affect a person’s everyday life, that’s when we might explore whether a person has a cognitive (thinking) impairment. Between 65-69 years of age around 1-2% of the population has dementia. As people age the risk increases. For people older than 90, around a third will have dementia.

As an occupational therapist, I often screen people for cognitive impairment. It’s normal not to get 100% on these tests. If there’s no big issue, it’s a good chance to talk about preventing dementia. While sometimes dementia happens, there’s things you can do to reduce your risk. For example, keep learning new things, get regular exercise and good sleep, and managing hearing loss.

If there is an issue, health professionals can help make like easier. Sometimes it’s about getting services in place. Sometimes it’s a simple thing like a stove timer, or an electrical plug timer, so that the stove or iron isn’t left on. If someone you know seems to have changes in their thinking or behaviour, consider a gentle conversation to encourage them to see a GP or other health professional. Try words like, “I’ve noticed that..”, “I can imagine it must be frustrating when..”, and “I’m wondering if it might be helpful to check in with..”.

With Spring well and truly here and rain coming back, many people around the Mary Valley will be seeing new life spring forth. It might be new shoots or baby chicks. The flip side of new life is that all lives end. In healthcare, when we support people and their family and friend before, during and after death we are providing end-of-life care.

An approach that’s often taken is called palliative care. In palliative care the focus gradually shifts from extending life (sometimes with lots of adverse side effects) to maximising quality of life and comfort. While death is the endpoint, palliative care aims to give people the opportunity to having as ‘good’ a death as possible. Grief can be a slow process and can start before the person dies as family and friends come to terms with the person’s mortality.

For me this is front of mind as two of my research students are tackling topics associate with end-of-life care. One student, Elli Pukallus, evaluated the Handover Bags initiative of the Sunshine Coast Hospital and Health Service. In many hospitals and aged care facilities across the world, the deceased persons belongings are left for family in garbage bags, often printed with the words “general waste”. Usually this was because these bags were all that was available. The Handover Bag project brought in the use of a non-dyed paper, printed with a purple tree symbol. The bag provides the dignity of privacy for the deceased’s belongings. Clothes are neatly folded inside, and the family can sort through the bag in their own time. Little gestures can make a big difference to people who are grieving.

Another student, Genevieve Kingston, is looking at how we can incorporate the perspectives of family and friends in improving hospital and health systems for end-of-life care. She will be using an occupational therapy process called the Kawa Model, where she will use a river metaphor to help people talk about what helped and hindered good quality care around their loved one’s death. Hopefully I can report back the findings in a future column.

Telehealth is broad term for healthcare that is not face-to-face. It could be as straight-forward as a phone service (e.g., 13HEALTH or Lifeline) or could be a lot more complex like an app on interactive website.

In my work, telehealth is now commonly done through the internet using video conferencing. You can see and hear your health professional and they can see and hear you. We can use telehealth for more than you think. As an occupational therapist I can do most simple home modifications (e.g., grab rails, ramps) by telehealth, as long as there is a helper (e.g., family member) who can carry the tablet/smartphone/computer around the home and use a tape measure under my instruction.

Telehealth can be used for people with most conditions, such as heart conditions, kids with autism or people with depression and anxiety. Some healthcare even works better online. For example, psychologists often worried they couldn’t connect with people online, however in reality some people open up more from behind a computer screen.

Telehealth might be right for you if you want or need to avoid travel (e.g., long distances), if face-to-face isn’t good for you (e.g., a compromised immune system), or if you want to access a specific health professional, potentially anywhere around the globe, who has focussed expertise to support you.

I see three common challenges. Firstly, you will need to have a phone or computer and a decent phone coverage or internet connection. A reasonable quality camera on your smartphone or computer can be a bonus. Secondly, you might need to tackle your uncertainty. Usually it is a simple as clicking on a link that the health professional emails to you and following the prompts. I’ve found I can nearly always talk someone through it. Thirdly, my biggest challenge is finding health professionals willing to provide telehealth. Some do it comfortably full-time, while others can feel uncertain, disbelieving or unprepared around trying something new. Some funding systems are more open to telehealth. As an area of expertise, I am happy to help people brainstorm their telehealth journey.

Work is an important part of most peoples’ lives. Beyond the economic benefit of working, working can bring a sense of satisfaction and purpose. Work creates a social circle, and for many a longer life expectancy.

If you’re off work from an injury, you can lose a lot of these benefits. Injuries can be physical or psychological. It can be tempting to take time away from the workplace, especially if you’re not enjoying your work. However, people who spend longer away from work have worse long-term outcomes. Return to work, even for a few hours a day, doing tasks which you can safely do, will improve your recovery. You can increase what you do over time. These are called “suitable duties”.

Your workplace’s Rehabilitation & Return to Work Coordinator (RRTWC), or a suitable health professional, can help you negotiate suitable duties. Interestingly, the workers compensation authority in Queensland removed the need for specific qualifications for RRTWCs about 7 years ago, although from 1^st July 2020 they now require an appropriately qualified person for some workplaces and industries.

Having a supportive supervisor strongly predicts how well people return to work for both physical or psychological conditions. A skilled health professional or RRTWC will ask you about how well you get along with your supervisor, and intervene with the employer if needed. Your employer has a legal responsibility to provide a safe workplace. This provides them with incentives to make reasonable changes. If you’re unsure, seek a second opinion. Your GP can help you with workers compensation claim documentation. Some doctors (occupational physicians) and allied health professionals have specific expertise in return to work and can suggest changes.

As always, prevention is better than cure. If you can, speak about things that might put you at risk of physical or psychological injury.

For those with a health condition or disability, there are a lot of systems out there that can help. In Australia, we’re lucky enough to have a good health system compared many other countries. This is based on both efficiency and healthcare achievements (World Health Organization, 2021). We still have something to learn from our French, Canadian, Italian and United Kingdom colleagues. In this and next month’s column, I’ll help unravel some of the different systems.

Medicare

Medicare is part of Australia’s universal health system. This means that every citizen can get affordable access to at least basic healthcare. Medicare provides funding for you to access a general practitioner (GP), as well as other services. Sometimes your GP will bulk bill you (which means no out of pocket expenses). At other times you may need to pay a gap fee. This is because Medicare rebates (the amount that the government pays) haven’t kept up with the rising cost of living. Medicare also has some schemes for people with specific needs. To access these schemes, you need to be eligible and have a GP or specialist referral. For those with complex long-term conditions, you can be referred for up to 5 allied health sessions (e.g., physiotherapist, dietitian) per year. The rebates only cover about 20-30 minutes of your allied health professional’s time, so you may be charged a gap fee. Other examples are the Better Access (to mental health clinicians) or Helping Children with Autism programs.

13HEALTH

13 HEALTH is available 24 hours a day, 7 days a week for free. 13 HEALTH is best if you have a new health condition that is not an emergency, but you’re not sure what to do about it. For example, one day I woke up with double vision out of the blue. My GP could not fit me in, and I didn’t know whether I should be worried about it. When you phone 13 HEALTH (call 13 43 25 84) you talk to an experience registered nurse. It was useful to have someone to talk to. It put my mind at ease knowing I could wait for my next GP appointment and phone back for more advice if my symptoms changed.

National Disability Insurance Scheme (NDIS)

For Australians living with a disability, the NDIS was design to help them live as ordinary a life as possible, with access to support services, therapies, assistive technology (e.g., wheelchairs, prosthetics), and home modifications. Not all people with disabilities are eligible for the scheme. Firstly, you must be under 65 when you apply and have a permanent and significant disability. If you apply for the scheme, you’ll need reports from your GP as well as other health professionals (often an occupational therapy report). The scheme is a big change to the systems that we had before, but there’s still a lot of challenges. On the one hand, people now have much more flexibility with who they see and what they would like to achieve. On the other hand, there’s usually a lot of justifying and paperwork (e.g., 4-10 hour reports) to get things, especially more expensive things. For every request, the agency looks at whether it is ‘reasonably and necessary’, whether it’s cost-effective, supported by evidence, and whether it should be provided by another system (such as health or education). It can be very frustrating and confusing. However, we do have a lot of success stories.

My Aged Care

While many older Australians (over 65) are fit and healthy, for those who have significant health conditions or disabilities they are usually eligible for My Aged Care. My Aged Care can give people access to subsidised support services (e.g., support workers, home cleaning), therapies, assistive technology, and home modification. You must be aged 65 years or over. If you think you may be eligible for My Aged Care you can call 1800 200 422 or apply online. Someone will visit you to do an assessment. Once you’ve been assessed they will tell you how much support and what types of support you’re are eligible for. My Aged Care isn’t as flexible as the NDIS, but in some ways it is simpler.

There are a lot more schemes out there. Talk to your GP or health professional if you are unsure where to get support.

References

Murray, C.J.L., Lauer, J., Tandon, A., et al. (2021). Overall health system achievement for 191 countries. World Health Organization Discussion Paper Series: No. 28.

Tandon, A., Murray, C.J.L., Lauer, J.A., et al. (2021). Measuring the health system performance for 191 countries. World Health Organization Discussion Paper Series: No.30

When we think of health professionals, we often think of the most common health professionals like nurses, physiotherapists and psychologists. There are a lot of different health professions out there, each with their area of expertise. With a renaissance in telehealth, rural and regional Australians have easier access to wider variety of health professionals than ever before. In this month’s column I’ll highlight two of the less common ones.

Music therapists

Music therapists use music to improve health, functioning and wellbeing. Sometimes it’s about providing music to stimulate thinking, improve mood or reduce pain. At times, the music therapist will help the person make music. For example, playing drums could help a child with cerebral palsy rehabilitate their arm and hand movements, help a teen with mental illness express their emotions, or help an adult who has Autism to interact and communicate with others. You can find music therapists in lots of places like hospitals, schools, aged care facilities or private practice.

Prosthetists and orthotists

Orthotists and prosthetists assess for, prescribe and make orthotics and prosthetics. Orthotics are things like splints or braces (e.g., to help straighten someone’s spine). While some other health professions (like physiotherapists or occupational therapists) do some orthotics (like hands splints), orthotists have more expertise in some types of complex orthotics. Prosthetics are artificial limbs or body parts, used if someone has had an amputation or was born without a body part. Prosthetic technology has advanced in recent years, with more robotic options and an increase in osseointegration rates. Osseointegration is where a surgeon puts a metal post in the remaining bone that comes out through the skin. The prosthetic can then connect directly to the bone which can make the prosthetic more stable and help the person feel the prosthetics movement better.

There’s many more health professions out there, such as arts therapists, genetic counsellors, orthoptists (working with eye movement), rehabilitation counsellors (helping people get back to work) and sonographers (who take ultrasounds). Find out more at Allied Health Professions Australia. In a future column I’ll introduce you to the role and history of Nurse Practitioners in Australia.

Nurses have a long and distinguished history. Nurses are often on the front line of healthcare, and can be found in many places such as hospitals, community centres, general practices, schools and prisons. Registered Nurses are the largest health profession in Australia, and this year around 1 in 47 working age Australians are Registered Nurses¹.

This month’s column focusses on a smaller group of nurses who have completed further study and work at a more advanced level as a Nurse Practitioner. There are currently 2,212 Nurse Practitioners in Australia. Queensland leads the way with 568 registered Nurse Practitioners.

You may not have come across a Nurse Practitioner before. Nurse Practitioners work autonomously, and diagnose and treat health conditions. They can order and interpret diagnostic tests such as bloods and x-rays. They can also prescribe many medications and make referrals to other health providers.

Nursing Practitioners often work closely with general practitioners or medical specialists. They can help to share the load on the health system, especially in areas like rural & remote practice and mental health where it can be difficult to get to see a doctor. Nurse Practitioners typically have longer consultations than GPs and typically provide more information^2,3,4. If you need a little more time for your consultations, then a Nurse Practitioner may be a helpful addition to your healthcare team. Having a Nurse Practitioner as part of a team can help GPs to focus on more acute of complex cases⁵. Becoming a nurse practitioner also provide a career pathway for exception and dedicated nurses who want to go one step further. You can find Nurse Practitioners in some hospital and general practices across the Sunshine Coast.

References

1. Nursing & Midwifery Board of Australia (2021). Nurse and midwife – registration data table – 31 March 2021.
2. Gysin, S., Meier, R., van Vught, A., et al. (2020). Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study. BMC Family Practice, 21, 164.
3. Kinnersley, P., Anderson, E., Parry, K., et al. (2000). Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting “same day” consultations in primary care. BMJ, 3201043-8.
4. Seale, C., Andersons, E., & Kinnersley, P. (2005). Comparison of GP and nurse practitioner consultations: an observational study. British Journal of General Practice, 55(521), 938-43.
5. King, J., Corter, A., Brewerton, R., & Watts, I. (2012). Nurse practitioners in primary care: benefits for your practice. Australian General Practice Network, Auckland.

Many of us like to be informed about our health and our health choices. Living in the digital age, we have a wealth of information at our fingertips. However, not all information out there is accurate or helpful.

Health practitioners are trained on how to find and interpret research. They learn the basic sciences (such as physiology, biochemistry, and psychology) to understand the field, as well as statistics and research methods to critique the research. It takes many years to become a good researcher. Health practitioners use research findings, alongside their own clinical experience and their understanding of your needs, priorities and values, to help you decide on a treatment plan. Not all health practitioners are equal, and some spend more time making sure they are up to date with the research evidence.

While there is no substitute for health professional training to understand health research, many people feel more empowered if they can find out more about their health conditions or needs. A basic Google search can lead you to finding information that is wrong, misleading, or potentially damaging. Here’s some ideas for better places to go.

1. Association websites. If you are looking for basic information about your condition, many reputable associations have excellent websites and fact sheets. For example, Healthy Bones Australia has information on osteoporosis and the Black Dog Institute covers mental health conditions. Most of these fact sheets are written in easy-to-read language.
2. Research databases. If you are looking for more scientific information, try skipping Google and going to a proper database. Two examples are PubMed and the Cochrane Library. PubMed provides you with summaries (abstracts) of research articles. Some abstracts even have links to the full articles. The Cochrane Library showcases systematic reviews, which is where people have summarised and critiqued the research on specific topics. Scientific writing can be difficult to read, but is worth the effort.

Assistive technology is near and dear to my heart as an occupational therapist, although speech pathologists, physiotherapists and rehabilitation engineers also prescribe assistive technology. Assistive technologies are products that people use to help them do everyday activities when injuries, illness or disability make life difficult.

As an occupational therapist, I help people to discover, try, choose, apply for, setup and learn how to use assistive technology. Some assistive technology comes from disability suppliers, like mobility scooters, wheelchairs. Others you can pick up from a supermarket or pharmacist, like a long handled reacher or a potato peeler with an extra wide grip that is easier to hold.

While some assistive technology can be very expensive, sometimes we can use everyday, low-cost items to solve problems. For example, for a person whose sight is poor, using a ping pong ball in a mug can help them to feel when their cup of tea is getting full, without burning their fingers. Or a smart watch could be used for people who have difficulty remembering, wander, or need help planning their day. When the only option is expensive equipment, we usually look to apply for funding or to source second hand equipment. We’ve had some very generous clients who have donated equipment they no longer needed and we were able to pass it on for free to others who couldn’t afford it.

There are amazing and complex options out there, such as eye gaze devices that allow people to control a computer using just their eyes. When we can’t find something just right, one of my favourite pastimes it to design and make equipment. You’ll often find me shaping foam or working with tools to make something new. My colleague, Christine, hooked up a big button switch to an electronic toy unicorn that had a small switch that was too difficult to use.

Picking the right assistive technology or customising it to your needs can be challenging. For more expensive or risky equipment, it’s best to get advice from an allied health professional who has expertise in the type of equipment you might need.