Wednesday, 17 February 2016

An Example of a Kallah in need of Occupational Therapy

I have received a few emails today, asking me to pray for a young lady who is in critical condition after a car accident. A few days ago, I was networking at a meeting and most who attended did not understand my niche or specialty, let alone occupational therapy itself. When I mentioned that I specialize in assisting Jewish women in the role of wife and mother I was told that this is what a life coach does.

Though prayer is crucial, appropriate treatment is also very important. I do not know this young lady or which hospital she is in, neither do I know the full extent of her injuries. I decided to write some ideas of what I could offer in the hope that Jewish women can come to understand the profession of occupational therapy and why it is important.

As mentioned, I have not heard much about this young lady. What I understand is that she is or was in a coma and among her injuries she has a severely injured hand and severely injured foot. She is also a Kallah (bride) due to come to Chuppah (wedding canopy) in just 2 weeks. This information is enough to already give an outline of how my service could assist her. 

If anyone looks at my website you will see that my services are divided into assisting women who are at the phase of:

To this end, in addition to being a licensed and experienced occupational therapist, I am also certified as a Kallah teacher, and have certification as an infant massage instructor as well as doing energy work.

The young lady in question would fall into the category of someone working on the phase of life to become a wife. In a normal world, she should be very busily preparing for her wedding. Any therapeutic intervention has to take this important life event into consideration. I would also recommend that both the Chatan and her mother are included in the therapy sessions, the goal setting and planning and the sessions themselves.

As some of my work experience, I have worked with poly trauma, including coma stimulation, I have also worked in two hand clinics. At this stage, much of the focus of intervention would be support to the family, support to the young lady herself, appropriate positioning and monitoring for potential to introduce therapy. The extent of coma stimulation that could be provided at this stage would be guided by the doctors in charge. Passive movements and elevation of the hand will also be important in order to reduce limit the extent of swelling. Swelling is a natural result of a wound especially in the hand. Depending on the injury, splinting might also be important so as to prevent contractures and maintain range of movement. 

Once the Kallah has regained consciousness there will be much need for physical rehabilitation. G-d willing, this Kallah will pull through and will then begin active physical rehabilitation. Without knowing the exact details of her injuries, let us look at a few of the activities of the Kallah. What does a Kallah usually do and what would be required of her in order for her to come to Chuppah successfully?

Let us pretend for a moment that the wedding is to take place and the Kallah is preparing for going to the Mikvah, a usual task for all Kallot. This Kallah will not be able to be guided by a regular Kallah teacher, there are many factors from her injury that will impact on her ability to prepare for the Mikvah and to immerse. I would therefore recommend a Kallah teacher who is also an occupational therapist. Let us take a look for a moment on some of the process of preparing for the Mikvah. To begin with is the process of recording certain details on a calendar and carrying out certain internal checks to make sure that her cycle is clear and she has counted 7 white days between the end of her cycle and the date of her immersion. There are a number of details that need to be remembered, not to mention the need to write down certain information. I do not know which hand was injured or what her dominance is, however she would need to be able to write in order to carry out this task. If writing is a problem, an alternative method needs to be determined according to her functional needs in OT and that is in keeping with Hallachah (Torah Law). As for the details to remember, someone who has been in a coma can have difficulties with memory, concentration and other cognitive or perceptual problems. These details will need to be evaluated in order to determine whether she can carry out these tasks and if not, what intervention is required so that she can gain the necessary skills. 

Next she will need to have a good bath, washing and combing your hair, cutting your nails of both hands and feet and cleaning them effectively in order to make sure that there are no intervening substances. If one takes a moment to think about the details involved in washing oneself, ones hair, getting in and out of the bath etc, this task requires a number of functions of both hands. Many tasks are bilateral. In addition, good balance is required in order to get in and out of the bath. However, before we can get to this, both her hand and her foot have to be healed sufficiently that they can be put into the water with no risk to infection. If there have been sutures (stitches) these have to be removed or resolved before immersing in a Mikvah will be possible as the stitches themselves become an intervening substance. This means that aside from the fact that she is in a coma, the stitches themselves would take 10 days to two weeks before they can be removed. Let's pray that there is no infection that develops, the mere fact that the stitches need to be removed and there needs to be no risk of infection is a clear indication that a wedding date in just 2 weeks might already become a problem. If the rabbis permit the wedding to take place while the Kallah is in hospital, that introduces a certain unspoken strain which would have to be worked with in therapy.

Let us pretend that she managed her bath and is now proceeding to go to the Mikvah. Once again she will need to check herself prior to going from the bathroom to the Mikvah. In addition to washing herself, checking herself, washing and combing her hair, she has to be able to undress and to dress herself. Regarding the Mikvah, she will need to follow the questions of the Mikvah lady which means being able to understand them and to remember the information to answer correctly. G-d willing her cognition and perception will be fine and she will be ready to immerse. The next stage requires walking down the stairs into the Mikvah itself. This requires balance and good function of both feet. In the event she is not yet able to stand and walk on her feet including going up and down the stairs she will need to be taken to a Mikvah that is adapted to accommodate for physical deficits. This will need evaluation and teaching her of how to use the adapted Mikvah in the event that this is necessary.

Notice, we have not yet got to all kinds of exciting tasks such as getting in and out of her bridal gown, having her hands and nails prepared, having her hair done, being able to walk to the Chuppah or finding a suitable means of mobility for her.

These will all become goals in treatment and have to be carried out with infinite sensitivity. Aside from the physical deficits and physical rehabilitation, there are a number of psychosocial factors that will need to be addressed which again fall into the role of the occupational therapist to work on with her and appropriate family members, especially her groom.

Let us pretend that she managed to come to Chuppah; since she is a young adult it will be important to look at other activities that will be necessary for her to carry out in her role of new wife, these can include cooking, shopping, meal planning, cleaning, setting up her new home, doing the laundry, safety in the kitchen. She will also have to look at what her profession or work are and to ensure that she is able to return to work and carry out her job effectively. If she is a student then the tasks / occupations necessary for her to complete her course will become important. If you spend a moment to think about the daily tasks that you carry out from when you get up in the morning to when you go to sleep, many of these tasks will be bilateral which means a need for good hand function. Being a Jewish young woman, she will have other tasks that are important too such as when she is in the kitchen, can she do what is necessary in order to keep Kosher in addition to basic cooking and meal preparation skills? Can she wash her hands? Using a special cup that has two handles in order to wash her hands as is required when waking up in the morning, after going to the toilet, when wanting to eat a meal that includes bread. This means not only being able to coordinate both hands to be able to pour the water over one hand and then the other, but she will need to have sufficient muscle strength to be able to pick up the washing vessel filled with water, with her affected hand. If her muscle strength is not strong enough to manage this, an alternative method needs to be determined that will still be in keeping with Torah. 

Some of the tasks mentioned thus far will be part of future planning with other short term goals being set and worked towards depending on her medical condition. In addition to the details that have been outlined above, it is important to find out what her interests are and what other tasks will be important for her to be able to carry out.

I wish this young Kallah a Refuah Shelayma - complete a speedy recovery. I hope that writing some information of a few obvious areas that come to mind in my capacity of occupational therapist, healing facilitator and Kallah teacher will help the reader to begin to understand how occupational therapy combines with being a Kallah teacher and the potential need for this. I hope too that it will begin to become evident how occupational therapy is not life coaching. Yes many occupational therapists use coaching and many have become life coaches, wellness coaches etc, however there is a difference. If anyone reading this knows the Kallah, you are welcome to be in touch. Please note, I would only be able to work with this young lady with a doctor's referral. Whether the Kallah would be referred to me or another OT, she will still be in need of effective occupational therapy intervention.

Friends, don't waste time. If you are in need of this type of assistance, check out my site TODAY. Be in touch with me either via my website or my email. I would be delighted to assist you whether it come to matters of healing, whether it comes to needing occupational therapy, whether in terms of learning the laws of family purity or any of the other services that you will find on my website.

I look forward to hearing from you.

Occupational Therapist, Healing Facilitator
Certified Kallah Teacher
Certified Infant Massage Instructor
Co-author of "Tuiva Finds His Freedom"

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