REHAB ROLES April, 2008
Dietitians Dietitians are professionals with the qualifications and skills to provide expert nutrition and dietary advice. They translate the latest scientific information into practical advice about what to eat. Dietitians are qualified to advise individuals and groups on nutrition-related matters. They also have the clinical training to modify diets to treat, or help to manage, conditions such as diabetes, heart disease, obesity, cancer, food allergies and intolerances. Dietitians work in a range of fields Dietitians work across many different fields, including: Patient care dietitians in hospitals and nursing homes develop menus to meet patients nutritional needs. This includes people recovering from illness or surgery and those with health problems like diabetes, heart disease or swallowing difficulties and poor appetite. Dietitians educate patients and family members on eating well and work with them to ensure diets meet individual needs. Private practice and consultancy dietitians work with individuals, groups and organisations to provide dietary advice and run health and nutrition education programs and seminars. They may also provide nutrition and health information to the media. Community and public health dietitians work to improve eating habits, health and wellbeing at the local level (such as practicing out of community health centres) or at state or national levels. Food industry dietitians work to improve the nutritional quality of foods, develop nutrition education campaigns, promote food safety and work with food laws and regulations. Research and teaching dietitians investigate the links between food and health to improve their knowledge of how diet can promote good health and prevent disease. Dietitians also teach in universities. Sports nutrition dietitians help athletes, sporting clubs, children and those interested in fitness to eat better to achieve their goals. Their advice may be related to helping people achieve peak sporting performance or improved energy and activity levels. What to expect - An initial consultation may run from 45 minutes to an hour. The dietitian will ask detailed questions about your current diet, exercise habits, general health and lifestyle. These questions allow the dietitian to tailor an individualised eating plan. - If you have a specific medical problem and have been referred to a dietitian by your doctor, the dietitian will work in close consultation with your doctor and may review blood and other test results to devise a suitable diet. You may be given written materials to take home. - Follow-up appointments allow the dietitian to keep track of your progress and fine-tune your eating plan. The dietitian s ultimate aim is to educate you on how to eat in a way that will keep you healthy so that you can choose the best food on your own. For more information, contact: College of Dieticians of Ontario www.cdo.on.ca
Midwifery Defining midwifery According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics): - A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination. - The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures. - The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare. - A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units. This definition is controversial and not everyone agrees with the exclusion of traditional midwives who in developing countries often are the only people available to assist women in birth. Midwifery in Canada Midwifery was reintroduced as a regulated profession in Canada in the 1990s. After several decades of intensive political lobbying by midwives and consumers, fully integrated and regulated midwifery is now part of the health system in the provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec, and in the Northwest Territories and Nunavut. Alberta does not publicly fund midwifery. Midwifery is not yet legally recognised in the Atlantic provinces of New Brunswick, Prince Edward Island, Newfoundland and Labrador, or Nova Scotia. The governments of Nova Scotia and New Brunswick have introduced midwifery legislation but have yet to commit to funding midwifery services if and when the bills pass. The legislation of midwifery has brought midwives into the mainstream of health care with universal funding for services (except in Alberta), hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place, informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution. Prior to legislative changes, very few Canadian women had access to midwifery care (in part because it was not funded by the health care system). Legislating midwifery has made midwifery services available to a wide and diverse population of women and in many communities midwives cannot meet the growing demand. For more information access www.aon.on.ca
Occupational therapy Occupational therapists are health professionals trained to assist people to overcome various limitations in order to live more independent lives. People may need assistance due to injury or illness, psychological or emotional difficulties, developmental delay or the effects of ageing. Occupational therapists work in many different environments including schools, nursing homes, hospitals and workplaces. Their goal is to maximise skills for living which enhance personal productivity, well-being and quality of life. Occupational therapists adopt a holistic approach to healthcare and treatment. They work with the individual, their family and other health professionals and care providers, where necessary. People of all ages and abilities can be helped by occupational therapy. Stages of treatment. An occupational therapy treatment program typically involves three stages: Evaluation - the abilities of the client are assessed in the context of their work, school, home, leisure, general lifestyle and family situation. Consultation - having made an assessment, the occupational therapist then consults with the client, other professionals and family members who may be closely involved in developing a treatment program. Treatment - this may take place in a clinic, hospital ward, residential care centre or at the client s home, school or workplace. The goal is always to maximise the client s skills for living. Occupational therapy and children Occupational therapy promotes normal development and stimulates learning in children with specific learning difficulties, physical disabilities, delayed development or those recovering from illness or injury. Working with children, their families and their teachers, occupational therapists aim to improve the child s quality of life by helping them to participate in play, preschool, school and home activities. An occupational therapist may work with children in any of the following areas: Prerequisite activities - the child s physical abilities, such as motor control, hand-to-eye coordination, body awareness and sensation. Functional skills - the child s day-to-day living skills, such as eating, writing, going to the toilet, interacting with other children and playground skills. The environment - such as classroom furniture, classroom and schoolyard access and equipment for woodwork, art and physical education. Occupational therapy for adults and the elderly When an adult or elderly person is affected by an illness, accident or work place injury, an occupational therapist can help them on the road to recovery. They may assist with the return to home and work life through the development of new skills for daily living such as household tasks and personal care, return-to-work or leisure programs. They may also make or facilitate changes to the work or home environment to make life easier and safer. Occupational therapy in psychiatry Occupational therapists also assist adults who are experiencing psychological or emotional difficulties. They can help a person develop better ways to deal with mental illness in the context of day-to-day activities, managing work and emotional problems. They work in conjunction with other health professionals such as psychiatrists, psychologists, social workers and doctors. Occupational therapy in the workplace Occupational therapists play an important role in helping workers return to work following an injury or illness, including stress. Their role in the workplace covers: Injury management and rehabilitation - including worksite assessments, injury risk assessments, occupational rehabilitation counselling and early intervention rehabilitation. Injury prevention - including manual handling assessments, claims history reviews, ergonomic assessments, development of an alternate duties manual, work conditioning programs and the redesign of workplaces. Training - in areas like stress management, manual handling, back care, safe work practices, the introduction of new equipment, work-station adjustments and work pause exercises. For more information, please go to Ontario Association of Occupational Therapists www.osot.on.ca
Physiotherapy The central aim of physiotherapy (physical therapy) is to restore proper functioning to the body. In the case of permanent disease or injury, the aim is to reduce the impact of the dysfunction. Contrary to popular belief, physiotherapists aren t limited to the rehabilitation of sports injuries and back pain. As well as musculoskeletal injuries, physiotherapists can also manage: Neurological conditions, such as stroke Multiple sclerosis and spinal cord injuries Cardiothoracic conditions like emphysema, asthma and chronic bronchitis. Physiotherapists can help a person to recover from surgery. Treatment options include a wide range of manual therapies, exercise programs and electrotherapy techniques, tailored to your specific condition. Your physiotherapist may work alone, or in collaboration with other health care providers, to offer a multifaceted approach to your rehabilitation. Physiotherapists also work in schools, community health centres, fitness centres and in the workplace. Three types of physiotherapy Physiotherapy is an effective form of treatment for a wide range of conditions. It can also help speed recovery after many different types of surgery. Physiotherapists are trained in a range of specialist areas such as paediatrics, sports medicine or women s health. Generally, the three different types of physiotherapy include: Musculoskeletal - to treat muscles, bones and joints (also called orthopaedic physiotherapy). Common conditions treated include back pain, sprains, strains, arthritis, bursitis, workplace and sports injuries, problems with posture, incontinence and reduced mobility. Rehabilitation after surgery is also offered. Cardiothoracic - to treat disorders of the cardio-respiratory system including asthma, emphysema and chronic bronchitis, and to offer rehabilitation after thoracic surgery. Neurological - to treat disorders of the nervous system including acquired head injuries, stroke, spinal cord injuries, Parkinson s disease and multiple sclerosis, and to offer rehabilitation after brain surgery. A holistic approach A physiotherapist works to improve your mobility and health and to reduce the risk of injuries. In many cases, an injury is caused by different factors working together. For example, persistent back pain may be triggered by a combination of poor posture, being overweight, repetitive work-related activities and incorrect technique when playing sport. The physiotherapist aims to treat the back pain, but also to address the factors which contribute to the cause. This approach aims to reduce the risk of the injury happening again. A range of therapies Physiotherapists draw upon a wide range of therapies, tailored to suit your individual needs. Some of these therapies include: Manual therapies - such as massage, stretching, manual resistance training, joint mobilisation and manipulation, including spinal mobilisation. Electrotherapy techniques - such as ultrasound, transcutaneous electrical nerve stimulation (TENS), laser therapy and diathermy. Exercise programs - such as posture retraining, muscle strengthening, cardiovascular training and stretching. Other services - taping and splinting, correcting flawed sporting techniques, providing or offering information on equipment aids such as wheelchairs and walking frames. For more information, please visit the Ontario Physiotherapy Association www.opa.on.ca
Social Worker Social work is a discipline involving the application of social theory and research methods to study and improve the lives of people, groups, and societies. It incorporates and uses other social sciences as a means to improve the human condition and positively change society's response to chronic problems. Social work is the profession committed to the pursuit of social justice, to the enhancement of the quality of life, and to the development of the full potential of each individual, group and community in society. It seeks to simultaneously address and resolve social issues at every level of society and economic status, but especially among the poor and sick. Social workers are concerned with social problems, their causes, their solutions and their human impacts. They work with individuals, families, groups, organizations and communities. Professional social workers have a strong tradition of working for social justice and of refusing to recreate unequal social structures. The main tasks of professional social workers can include a variety of services such as case management (linking clients with agencies and programs that will meet their psychosocial needs), medical social work, counseling (psychotherapy), human services management, social welfare policy analysis, community organizing, advocacy, teaching (in schools of social work), and social science research. Professional social workers work in a variety of settings, including: non-profit or public social service agencies, grassroots advocacy organizations, hospitals, hospices, community health agencies, schools, faithbased organizations, and even the military. Some social workers work as psychotherapists, counselors, or mental health practitioners, often working in collaboration with psychiatrists, psychologists, or other medical professionals. Additionally, some social workers focus their efforts on social policy or conduct academic research into the practice or ethics of social work. The emphasis has varied among these task areas by historical era and country. A variety of settings employ social workers, including governmental departments (especially in the areas of child and family welfare, mental health, correctional services, and education departments), hospitals, non-government welfare agencies and private practice - working independently as counsellors, family therapists or researchers. Types of clinical or direct practice Assessment and diagnosis Case management Clinical supervision Counseling or psychotherapy Psychoanalysis Crisis intervention Family therapy/family interventions Group therapy or other group work Child welfare o Adoption o Child abuse o Foster care Disability services Domestic violence Family planning Employee assistance programs Medical social work Forensic Social Work School social worker Substance abuse Aging or gerontology o Nursing home o Hospice o Reminiscence therapy Anti-poverty o Income assistance o Job training/placement o o Food bank programs Housing and homelessness Violence prevention Person centered planning Play therapy Psychosocial and psychoeducational interventions Relationship counseling and interpersonal counseling Relationship education Immigrant and refugee services and supports Anti-racism Lesbian, gay, bisexual, and transgendered supports For more information, visit: www.oasw.org
Speech pathologists Speech pathologists assess and treat people who have difficulty communicating. Communication is the process of being understood by other people and understanding them. It includes speech, reading, writing, signs and gestures. Speech pathologists also work with people who have trouble swallowing food or drink. Speech pathologists help people of all ages and also offer support to family members and care-givers. Examples of Clients Babies born with a cleft palate (speech pathologists give mothers advice about feeding) Children whose speech is difficult to understand Children with autism spectrum disorder People who stutter Accident victims with severe brain injury Stroke victims People who have difficulty drinking and eating without choking People with an intellectual disability People with hearing impairments People with illnesses that can affect speech (e.g. multiple sclerosis, Huntington s, cancer of the head, neck and throat) Scope of Practice Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of: Establishing augmentative and alternative communication (AAC) techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices.) Providing services to individuals with hearing loss and their families/caregivers (e.g.,auditory training; speechreading; speech and language intervention secondary to hearing loss; visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage). Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management. Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice. Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits. Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitivecommunication disorders. Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision makes about communication, swallowing, or other upper aerodigestive concerns. Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers. Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate. Addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positioning for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions. Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice). For more information, contact www.osla.on.ca