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Claire Jones
The Pubic
     Symphasis


•   “Lateral scissoring” can irritate a misaligned pubic symphasis.
•   Many activities create lateral scissoring motion, e.g. walking,
    running, climbing hills and stairs, carrying shopping or
    children unevenly.
•   Photo credit:
   “Volition, habituation and performance capacity are
    maintained and changed through what one does and
    what one thinks and feels about doing” p.27
   “A shift in volition, habituation, performance capacity
    or the environment can alter the overall dynamics,
    leading to the emergence of something new” p.28
Keilhofner, G. (2008) Model of Human Occupation, 4th
 ed.
 Volition                               Environment:
  • Driven personality                    • Housing-
  • High pain threshold                      Steep hill with no vehicle
                                              access
  • Pride in Joint breadwinner role
                                             Carrying shopping up the
 Habituation                                 hill
  • Very busy lifestyle                      Often carrying toddler up
                                              the hill
  • Long hours on feet
                                             Steep stairs in back-to-back
  • Used to running/ lifting/                 housing
    carrying                                 House on three floors
                                          • Work-
                                             Very busy M H Inpatient
                                              Ward
   Poor advice from GP and Midwife
      • outdated with reference to published research about PGP,
      • services under re-organisation led to use of locums without specialist
        expertise,
      • administrative and communication problems,
      • my pride- perhaps I didn’t state my case forcefully enough?

   Good advice from Doctor at work
      • recognised the problems with my gait and insisted I pursue the physio.
          referral, despite several unsuccessful attempts

   Finally, advice from Physio
      • Physio couldn’t believe I was still working with the level of injury

   Started OT on Wheels blog
http://otonwheels.wordpress.com/2010/06/26/so-what-happened-to-you-anyway-why-you-in-that-chair   /
 “Occupational   deprivation is...a state in which
  a person ...(is) unable to do what is
  necessary and meaningful in their lives due to
  external restrictions.
 Itis a state in which the opportunity to
  perform those occupations that have social,
  cultural and personal relevance is rendered
  difficult if not impossible.”
(Whiteford, 2000)
•Side lying with knees
gripping pillow is most
comfortable position

•It is surprisingly difficult
to do things in this
position!

•Started to use
painkillers and
mindfulness to deal with
pain
   Using services gave me valuable insight into the service user
    experience- things don’t always go the way we think they
    should!
   Took delivery of a bed-stick, two urinal bottles from OT- at last
    I can get out of bed independently!
   Blogged about attitudes of the staff and services I
    encountered, including Patient Transport
   If I can’t work the system, what hope has anybody?
   http://otonwheels.wordpress.com/2010/06/30/disabled-people-arent-allowed-to-be-parents-
    btw/
   http://otonwheels.wordpress.com/2010/06/27/a-few-examples-of-how-disabled-people-are-
    treated/
   http://otonwheels.wordpress.com/2011/04/29/patient-transport-again/
 DLA- Disability Living Allowance
  • Benefit in the UK for people to address the increased
        cost of living with disability
      • Very difficult process to claim, but necessary as a
        gatekeeper to other disability services
http://otonwheels.wordpress.com/2011/02/14/valentines-day-my-dla-story-ombh/
http://otonwheels.wordpress.com/2011/04/22/still-waiting-to-be-awarded-dla/
http://otonwheels.wordpress.com/2011/04/22/i-finally-won-my-dla-tribunal/
http://otonwheels.wordpress.com/2011/04/23/higher-rate-mobility-dla-it-means-freedom-i-hope/

 Motability
  • Scheme in UK where part of DLA is sacrificed to
         provide independent transport
http://otonwheels.wordpress.com/2011/05/16/all-aboard-the-motability-scheme-renault-review/
http://otonwheels.wordpress.com/2011/05/22/motability-scheme-citroen-c4-grand-picasso-review/
   Cried each night before
    going back up the stairs- it
    hurt so much
   Despairing about the future
   Hoping that after the birth I
    would recover quickly
   Blogged about problems in
    the home
    http://otonwheels.wordpress.com/2010/06/26/wh
    ats-the-access-to-my-house-like-rubbish-and-
    heres-too-much-information-about-how-it-is-in-
    the-house-too/
   Successful elective c-
    section

   Celebration shared
    through Social Media-
    #clairesbaby is born!

   Baby develops anaemia
    within first few hours of
    birth- soon becomes
    critically ill
 What is it?
   • Haemolysis leads to elevated bilirubin levels. After
     delivery, bilirubin is no longer cleared (via the
     placenta) from the neonate's blood
 Symptoms
   • Jaundice increase within 24 hours after birth.
 Treatment is
   • Phototherapy
   • Exchange blood transfusion

   http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_
    newborn
 #clairesbaby  Tweets
  became huge source
  of support
 Agreed treatment:
   • Triple phototherapy
   • Fed baby
     expressed milk
     under phototherapy
     lamps
So happy she was going
to make it!!




                         Allowed to resume
                         breastfeeding
                         And to pick her up for
                         cuddles
Bathing baby in hospital
                             breastfeeding room-
                             partner needed to carry
                             filled bath to table in order
                             for me to participate in
                             bathing



Looking after baby from my
bed- all dressing, nappy
changing and feeding done
in the same way.
PROBLEM                SOLUTION
   Couldn’t open         Make friends with the
    heavy fire doors       housekeepers, who
    from wheelchair-       brought me meals and
    need access for        tea!
    • Meals               Plan loo visits during
    • Toilet               visiting hours when
    • Shower               many people around to
                           hold doors
                          Have daily shower
                           when I have my own
                           visitors
I want to go home, but    Handy    grab
don’t know how I’ll       Toilet frame
manage!                   Urinals (downstairs
                           and bedroom)
                          Bath seat
                          Shower seat
                          Perching stool
                           (bathroom)
                          Bedstick
                          Trolley
                          Zimmer Frame
   Home Care helped to:         Blogs
                                 http://otonwheels.wordpress.com/2011/0
   Carry baby downstairs         1/23/the-woman-who-would-not-take-
   PADL                          off-her-shoes-in-which-i-discuss-my-
                                  disappointment-with-home-carers-lack-
     • Showering                  of-respect/
                                  http://otonwheels.wordpress.com/2011/
     • Dressing bottom half   
                                  01/23/social-care-the-forgotten-public-
     • Emptying urinals           service-in-which-i-discuss-the-lack-of-
                                  education-of-the-role-of-the-helping-
   DADL                          professions-in-our-primary-schools-at-
                                  key-stage-1/
     • Hoovering                 http://otonwheels.wordpress.com/2011/
     • Pegging out washing        09/23/a-funny-story-about-psychosis-
                                  in-which-i-discuss-occams-razor/
     • Making a cup of tea       http://otonwheels.wordpress.com/2011/
                                  01/23/social-care-the-forgotten-public-
     • Ironing                    service-in-which-i-discuss-the-lack-of-
                                  education-of-the-role-of-the-helping-
     • Making bed                 professions-in-our-primary-schools-at-
     • Washing up                 key-stage-1/
 Still in pain, but healing
  from the birth now
 Still find side lying to be
  best relief from pain
 Parenting tasks very
  difficult-
      Nappy changing
      Couldn’t carry baby
      Couldn’t bathe baby
      Couldn’t use oven
 My set-up each
 morning- reducing
 trips up and down
 stairs- keep
 everything handy!
   Receiving services- not
    providing services!
     •   Daily Home Care
     •   Family aide 3x weekly
     •   Social Services transport
     •   Wheelchair Taxi
   http://otonwheels.wordpress.com/2011/02/28/
    going-out-maybe-or-maybe-not-in-which-i-
    discuss-problems-booking-out-the-
    wheelchair-taxi-service/
   http://otonwheels.wordpress.com/2011/04/22/
    access-to-my-house-from-car/
     • Physiotherapy
     • Perinatal Mental Health
       Support
     • GP
     • Pharmacy delivery
 Found  online support
  networks to be
  invaluable
 Couldn’t get out to
  meet friends
 Couldn’t get to school
 Housebound, except
  when partner /
  wheelchair taxi took
  me for medical appts
Kubler-Ross                                 Impact on friendships:

Cycle of grief                              http://otonwheels.wordpress.co
                                             m/2011/09/19/so-good-to-see-
                                             you-back-on-your-feet-again-in-
Denial-Anger-Bargaining-Grief-               which-i-discuss-the-well-
  Acceptance                                 meaning-but-misinformed-
                                             friend/
   http://otonwheels.wordpress.co
    m/2011/01/23/life-changing-             http://otonwheels.wordpress.co
    injury-in-which-i-start-using-the-       m/2011/02/14/a-little-
    kubler-ross-stages-of-grief-             knowledge-is-a-dangerous-
    model/                                   thing-in-which-i-discuss-
                                             medical-student-syndrome/
   http://otonwheels.wordpress.co
    m/2011/06/02/feeling-rotten-
    sucks/
 Starting to accept my
 situation- assessing
 how I lived my life
 before and after
 disability




                          I didn’t miss my daughter’s
                          Nativity- first Family outing!
Spirituality
 http://otonwheels.wordpress.com/2011/09/24/
  faith-and-healing-in-which-i-discuss-faith-
  healing-prayer-and-christianity/
Family
 http://otonwheels.wordpress.com/2011/03/13/
  a-weekend-away/
 http://otonwheels.wordpress.com/2011/05/15/
  childcare/
 http://otonwheels.wordpress.com/2011/05/17/
  childcare-2-time-to-start-letting-go/
 Fit   for work?
   http://otonwheels.wordpress.com/2011/04/29/fit-for-work/
   http://otonwheels.wordpress.com/2011/06/09/telecommuting/

 Personalisation

   http://otonwheels.wordpress.com/2011/04/23/a-tale-of-
    personalisation-in-adult-social-care-personal-budgets-and-how-i-still-
    cant-access-them/

 Disablism

   http://otonwheels.wordpress.com/2011/09/17/disabled-or-just-lazy-
    scroungers-in-which-i-discuss-the-home-care-ladys-disablism/
 Pelvic   Instability Network Scotland
  • http://www.pelvicinstability.org.uk/pregnancy.asp


 Pelvic   Partnership
  • http://www.pelvicpartnership.org.uk/


 Wikipedia
  • http://en.wikipedia.org/wiki/Pelvic_girdle_pain
    Kielhofner, G. (2008). Model of Human Occupation (4th ed.)
     Lippincott Williams and Wilkins. Baltimore.
    Kübler-Ross, E. (1969) On Death and Dying, Routledge. Cited
     on Wikipedia. Accessed 17.35 25/10/11
[http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model]

    Whiteford, G. E. (2000). Occupational deprivation: Global
     challenges in the new millennium. British Journal of
     Occupational Therapy, 63(5), 200–204.
    Haemolytic Disease of the Newborn. Wikipedia. Accessed
     15.05 07/09/11
[ http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn]


    Nhs local (2011)Women with pelvic girdle pain left in agony
     unnecessarily. Thursday 31st March. Accessed 15.05 07/09/11
[http://nhslocal.nhs.uk/story/women-pelvic-girdle-pain-left-agony-unnecessarily]
Contact details can be instantly
  uploaded to your phone by
  scanning the QR code
  opposite.

E: tech4health@gmail.com
Blogs:
   Claireot.wordpress.com
   Otonwheels.wordpress.com
T: @claireot
G: +claireot

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Final #ot24vx presentation

  • 2.
  • 3. The Pubic Symphasis • “Lateral scissoring” can irritate a misaligned pubic symphasis. • Many activities create lateral scissoring motion, e.g. walking, running, climbing hills and stairs, carrying shopping or children unevenly. • Photo credit:
  • 4. “Volition, habituation and performance capacity are maintained and changed through what one does and what one thinks and feels about doing” p.27  “A shift in volition, habituation, performance capacity or the environment can alter the overall dynamics, leading to the emergence of something new” p.28 Keilhofner, G. (2008) Model of Human Occupation, 4th ed.
  • 5.
  • 6.  Volition  Environment: • Driven personality • Housing- • High pain threshold  Steep hill with no vehicle access • Pride in Joint breadwinner role  Carrying shopping up the  Habituation hill • Very busy lifestyle  Often carrying toddler up the hill • Long hours on feet  Steep stairs in back-to-back • Used to running/ lifting/ housing carrying  House on three floors • Work-  Very busy M H Inpatient Ward
  • 7. Poor advice from GP and Midwife • outdated with reference to published research about PGP, • services under re-organisation led to use of locums without specialist expertise, • administrative and communication problems, • my pride- perhaps I didn’t state my case forcefully enough?  Good advice from Doctor at work • recognised the problems with my gait and insisted I pursue the physio. referral, despite several unsuccessful attempts  Finally, advice from Physio • Physio couldn’t believe I was still working with the level of injury  Started OT on Wheels blog http://otonwheels.wordpress.com/2010/06/26/so-what-happened-to-you-anyway-why-you-in-that-chair /
  • 8.  “Occupational deprivation is...a state in which a person ...(is) unable to do what is necessary and meaningful in their lives due to external restrictions.  Itis a state in which the opportunity to perform those occupations that have social, cultural and personal relevance is rendered difficult if not impossible.” (Whiteford, 2000)
  • 9. •Side lying with knees gripping pillow is most comfortable position •It is surprisingly difficult to do things in this position! •Started to use painkillers and mindfulness to deal with pain
  • 10. Using services gave me valuable insight into the service user experience- things don’t always go the way we think they should!  Took delivery of a bed-stick, two urinal bottles from OT- at last I can get out of bed independently!  Blogged about attitudes of the staff and services I encountered, including Patient Transport  If I can’t work the system, what hope has anybody?  http://otonwheels.wordpress.com/2010/06/30/disabled-people-arent-allowed-to-be-parents- btw/  http://otonwheels.wordpress.com/2010/06/27/a-few-examples-of-how-disabled-people-are- treated/  http://otonwheels.wordpress.com/2011/04/29/patient-transport-again/
  • 11.  DLA- Disability Living Allowance • Benefit in the UK for people to address the increased cost of living with disability • Very difficult process to claim, but necessary as a gatekeeper to other disability services http://otonwheels.wordpress.com/2011/02/14/valentines-day-my-dla-story-ombh/ http://otonwheels.wordpress.com/2011/04/22/still-waiting-to-be-awarded-dla/ http://otonwheels.wordpress.com/2011/04/22/i-finally-won-my-dla-tribunal/ http://otonwheels.wordpress.com/2011/04/23/higher-rate-mobility-dla-it-means-freedom-i-hope/  Motability • Scheme in UK where part of DLA is sacrificed to provide independent transport http://otonwheels.wordpress.com/2011/05/16/all-aboard-the-motability-scheme-renault-review/ http://otonwheels.wordpress.com/2011/05/22/motability-scheme-citroen-c4-grand-picasso-review/
  • 12. Cried each night before going back up the stairs- it hurt so much  Despairing about the future  Hoping that after the birth I would recover quickly  Blogged about problems in the home http://otonwheels.wordpress.com/2010/06/26/wh ats-the-access-to-my-house-like-rubbish-and- heres-too-much-information-about-how-it-is-in- the-house-too/
  • 13.
  • 14. Successful elective c- section  Celebration shared through Social Media- #clairesbaby is born!  Baby develops anaemia within first few hours of birth- soon becomes critically ill
  • 15.  What is it? • Haemolysis leads to elevated bilirubin levels. After delivery, bilirubin is no longer cleared (via the placenta) from the neonate's blood  Symptoms • Jaundice increase within 24 hours after birth.  Treatment is • Phototherapy • Exchange blood transfusion  http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_ newborn
  • 16.  #clairesbaby Tweets became huge source of support  Agreed treatment: • Triple phototherapy • Fed baby expressed milk under phototherapy lamps
  • 17. So happy she was going to make it!! Allowed to resume breastfeeding And to pick her up for cuddles
  • 18. Bathing baby in hospital breastfeeding room- partner needed to carry filled bath to table in order for me to participate in bathing Looking after baby from my bed- all dressing, nappy changing and feeding done in the same way.
  • 19. PROBLEM SOLUTION  Couldn’t open  Make friends with the heavy fire doors housekeepers, who from wheelchair- brought me meals and need access for tea! • Meals  Plan loo visits during • Toilet visiting hours when • Shower many people around to hold doors  Have daily shower when I have my own visitors
  • 20. I want to go home, but  Handy grab don’t know how I’ll  Toilet frame manage!  Urinals (downstairs and bedroom)  Bath seat  Shower seat  Perching stool (bathroom)  Bedstick  Trolley  Zimmer Frame
  • 21. Home Care helped to:  Blogs  http://otonwheels.wordpress.com/2011/0  Carry baby downstairs 1/23/the-woman-who-would-not-take-  PADL off-her-shoes-in-which-i-discuss-my- disappointment-with-home-carers-lack- • Showering of-respect/ http://otonwheels.wordpress.com/2011/ • Dressing bottom half  01/23/social-care-the-forgotten-public- • Emptying urinals service-in-which-i-discuss-the-lack-of- education-of-the-role-of-the-helping-  DADL professions-in-our-primary-schools-at- key-stage-1/ • Hoovering  http://otonwheels.wordpress.com/2011/ • Pegging out washing 09/23/a-funny-story-about-psychosis- in-which-i-discuss-occams-razor/ • Making a cup of tea  http://otonwheels.wordpress.com/2011/ 01/23/social-care-the-forgotten-public- • Ironing service-in-which-i-discuss-the-lack-of- education-of-the-role-of-the-helping- • Making bed professions-in-our-primary-schools-at- • Washing up key-stage-1/
  • 22.  Still in pain, but healing from the birth now  Still find side lying to be best relief from pain  Parenting tasks very difficult-  Nappy changing  Couldn’t carry baby  Couldn’t bathe baby  Couldn’t use oven
  • 23.  My set-up each morning- reducing trips up and down stairs- keep everything handy!
  • 24. Receiving services- not providing services! • Daily Home Care • Family aide 3x weekly • Social Services transport • Wheelchair Taxi  http://otonwheels.wordpress.com/2011/02/28/ going-out-maybe-or-maybe-not-in-which-i- discuss-problems-booking-out-the- wheelchair-taxi-service/  http://otonwheels.wordpress.com/2011/04/22/ access-to-my-house-from-car/ • Physiotherapy • Perinatal Mental Health Support • GP • Pharmacy delivery
  • 25.  Found online support networks to be invaluable  Couldn’t get out to meet friends  Couldn’t get to school  Housebound, except when partner / wheelchair taxi took me for medical appts
  • 26. Kubler-Ross  Impact on friendships: Cycle of grief  http://otonwheels.wordpress.co m/2011/09/19/so-good-to-see- you-back-on-your-feet-again-in- Denial-Anger-Bargaining-Grief- which-i-discuss-the-well- Acceptance meaning-but-misinformed- friend/  http://otonwheels.wordpress.co m/2011/01/23/life-changing-  http://otonwheels.wordpress.co injury-in-which-i-start-using-the- m/2011/02/14/a-little- kubler-ross-stages-of-grief- knowledge-is-a-dangerous- model/ thing-in-which-i-discuss- medical-student-syndrome/  http://otonwheels.wordpress.co m/2011/06/02/feeling-rotten- sucks/
  • 27.  Starting to accept my situation- assessing how I lived my life before and after disability I didn’t miss my daughter’s Nativity- first Family outing!
  • 28. Spirituality  http://otonwheels.wordpress.com/2011/09/24/ faith-and-healing-in-which-i-discuss-faith- healing-prayer-and-christianity/ Family  http://otonwheels.wordpress.com/2011/03/13/ a-weekend-away/  http://otonwheels.wordpress.com/2011/05/15/ childcare/  http://otonwheels.wordpress.com/2011/05/17/ childcare-2-time-to-start-letting-go/
  • 29.  Fit for work?  http://otonwheels.wordpress.com/2011/04/29/fit-for-work/  http://otonwheels.wordpress.com/2011/06/09/telecommuting/  Personalisation  http://otonwheels.wordpress.com/2011/04/23/a-tale-of- personalisation-in-adult-social-care-personal-budgets-and-how-i-still- cant-access-them/  Disablism  http://otonwheels.wordpress.com/2011/09/17/disabled-or-just-lazy- scroungers-in-which-i-discuss-the-home-care-ladys-disablism/
  • 30.  Pelvic Instability Network Scotland • http://www.pelvicinstability.org.uk/pregnancy.asp  Pelvic Partnership • http://www.pelvicpartnership.org.uk/  Wikipedia • http://en.wikipedia.org/wiki/Pelvic_girdle_pain
  • 31. Kielhofner, G. (2008). Model of Human Occupation (4th ed.) Lippincott Williams and Wilkins. Baltimore.  Kübler-Ross, E. (1969) On Death and Dying, Routledge. Cited on Wikipedia. Accessed 17.35 25/10/11 [http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model]  Whiteford, G. E. (2000). Occupational deprivation: Global challenges in the new millennium. British Journal of Occupational Therapy, 63(5), 200–204.  Haemolytic Disease of the Newborn. Wikipedia. Accessed 15.05 07/09/11 [ http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn]  Nhs local (2011)Women with pelvic girdle pain left in agony unnecessarily. Thursday 31st March. Accessed 15.05 07/09/11 [http://nhslocal.nhs.uk/story/women-pelvic-girdle-pain-left-agony-unnecessarily]
  • 32. Contact details can be instantly uploaded to your phone by scanning the QR code opposite. E: tech4health@gmail.com Blogs: Claireot.wordpress.com Otonwheels.wordpress.com T: @claireot G: +claireot

Editor's Notes

  1. The pubic symphysis is at the front of the pelvis
  2. The joint comes under pressureduring pregnancy. Painful, hot feeling. Eventually separated- “click” at night.After going off sick from work “temporarily”, took up blogging because it was an occupation I could perform lying on my side on the sofa!
  3. Mum, full time worker, many other hobbiesnever refused the extra demands e.g. Picking up child, shopping, extra shifts at workknew I was in pain but didn’t think it was “worth” stopping and listening to the painwe all took on extra shifts
  4. “restricted Occupational choice and limited occupational opportunities”“address occupationaldeprivation as part of their orientation toward social andoccupational justice
  5. Sidelying, can’t do much. Watch tv, films. Try computers. Cannot get stuff out and knit. Cant bake. Cant even get to garden, never mind do the gardening!GardeningBakingKnittingVisiting friendsSociableWork as very importantRelationship okay- planned babyUnable to get into garden, never mind gardening!Can’t bend down to ovenFrustrated- can’t even SIT!HouseboundWithdrawing from all social contactUnable to go to workRelationship rocky- carer stress.
  6. Profound anaemia can cause high-output heart failure, with pallor, enlarged liver and/or spleen, generalized swelling, and respiratory distress.It can be fatal. Was expected to make decisions about baby’s care- At 2.30amNo partner for supportWhen in considerable pain18 hours after Section,
  7. Was too distressed to speak to people in person. Only saw my partner. Used social network “Twitter” as secondary source of support-
  8. Ante-natal ward has far fewer staff, therefore no support available for day-to-day looking after baby. I enjoyed being able to care for my now growing healthy baby!
  9. Equipment had to be in place for me to manage at home. No equipment could be issued through ante-natal, but an OT from oncology was able to issue it.