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some cute wild flowers I noticed growing by a Lehigh building :) 

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My first walk was around the campus of Lehigh University and the south side of Bethlehem. It was a beautiful 70-degree fall day and by the end of it, I was overheating. Luckily, I chose a route that ended with a cute breakfast cafe so I was able to rest before heading home. I would say I'm a very observant individual, and especially when I'm alone, I tend to take note of small things and give them big meaning. What does that mean? Well, on this walk I was able to observe a lot of human interactions with other humans, with phones, with books, and with animals. One interaction that stood out to me was the reunion of what I assume was two parents and a grandparent meeting with a Lehigh student in the courtyard of the dorms. The student embraced his parents, but grandma's hug was a little bit longer. Why did I notice this? Most likely because I lost both my grandparents within the last 3 years and I envy those who still get time with theirs. I wondered about grandpa and where he was on this particular day, did he have to stay home maybe due to illness or impairment, did he just not want to come, or was he no longer in the picture. This small interaction, one I'd pass by hundreds of times, was suddenly a huge part of my day and a reminder to cherish the times you have with those you love.

I recorded some small flowers growing on a side street that I've passed a bunch of times before, but often at night so I wouldn't have noticed them in the past.

I was pleasantly surprised to see a group of puppies training to become service animals. I watched as countless individuals went up the puppies and immediately started petting them. I've noticed this is a common occurrence and haven't done much about it before but was introduced to how this really affects people when we visited Sights for Hope and they informed us of the problem it creates. I learned so much from that day and finally saw that as future OTs, we have a huge role in advocating for our clients, but we also in advocating for their needed services, including service animals. It's our duty to inform the public and spread awareness of the importance of asking before petting a service dog, and explaining why they need to remain alert and focused on their owner, because our clients deserve to participate without hinderance. Because of this walk, I learned to think critically about my surroundings and about interactions and framing them in terms of OT and OT practices, as well as how I can use them to gain knowledge and insight in real time.

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here's my dog hiding behind my leg because there were loud booms from the garbage truck that was emptying a dumpster at a local restaurant on the route

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For this week's walk, I decided to walk through the community of one of my most memorable patients from my level ID fieldwork this summer. My fieldwork was at Kessler Institute of Rehabilitation in West Orange, NJ so I felt very at-home and felt a sense of relatedness to the patients and their struggles. This particular patient had a huge impact on my time at this fieldwork site because this patient had late stage dementia, a R CVA with left hemiparesis, and was a father/new grandfather, yet he had no clue what his situation meant. This patient reminded me of my grandmother, who passed from Alzheimer's in 2019, but hid this extremely well until her CVA and a fall that resulted in a hip fracture and due to her declining health and the risks associated with anesthesia was inoperable. My patient, much like my grandmother, was always smiling, always giggling, always making funny faces with me when the OT looked away, and unfortunately so unaware of just how much his life was changing on top of his confusion and memory deficits. So this patient was to be sent home, but his son admitted he could not care for him full time and they could not afford to have a home health aide or in-home care. Eventually the patient was discharged home with the plan being that his son would move in with him and he would be dropped off at a local adult day care while his son went to work.

So I learned that this patient happened to live near my uncle in New Jersey and because I was home this weekend I was able to pay a visit to his community. I took a walk with my little cousin and my dog Mochi (Moe) through the neighborhood and thought of that patient along the way. Some of the things I noticed immediately were the sidewalks and how uneven they were, the noise and foot traffic, the amount of people outside and the roads/safety of those roads. For a patient with L hemiparesis, this route was almost completely unmanageable and un-walkable. For a patient with dementia, this route was not calming or safe. My little cousin was hard enough to manage and keep out of the road because she likes to wander and do cartwheels in the grass. I couldn't imagine having to care for a patient with both his physical challenges and cognitive difficulties. This patient would need so much assistance and cueing to remain safe. The sidewalks were barriers because of his walker and trouble lifting his left leg, the noise and people around would be too distracting and maybe even disorienting, and the traffic/roads being so busy and unpredictable would be so unsafe should he accidentally wander or try to run off, which he did often at the inpatient rehab. He would suddenly get up and take off without his walker and completely defy his deficits, it was truly so interesting. So this walk wasn't eye opening for me necessarily, but it was meaningful, influential for my future and how I think about discharge for my patients in terms of community and not so much in-home barriers. I gained a little bit of insight into how difficult it is to say you can help a patient get back to their community, while also keeping in mind how everywhere is different, and these contexts and factors that are specific to each patient that pose as barriers.

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During break, I was able to visit an old family friend and ask if she wanted to walk with me. She agreed and thanked me for thinking of her. I noticed almost immediately how incredibly slow she was with getting out of her chair. I started questioning whether she should join me in the walk, but considering her diagnosis, last I heard, was mild arthritis from aging, I let it slide. She lives in an apartment complex so we had to make our way to the elevator to leave. We laughed about it afterwards, but really, I made my way to the elevator, then held the door open until she got to me, slowly but surely. Again I asked if she was sure she could walk today, if she was in any pain, feeling okay, all things she politely answered by saying, "I'm fine, it will be good for me." I kept a close eye on her anyway. As we got outside, I noted the prominent bowing of her legs that I never saw before. She walked with a waddle, and awkwardly stepped up and down from curbs, but she did it without assistance. So we walked, very slowly, for about 5 minutes before she needed to rest. While we rested, I asked if she had been leaving the apartment recently for anything fun, and she said no. I asked if she felt there was anything specifically keeping her from leaving more often, fully expecting her to say arthritis, but she said "oh I didn't tell you? I was diagnosed with osteopenia on top of my osteoarthritis." So, at this point, I debated if we should turn around because I didn't want to cause any problems or pain, but she insisted on walking just down the block and back because her doctor said it would be good for her. This was one of the contextual factors other than her diagnoses, that I took mental note of. Rapport building was somewhat natural, but I sensed a loneliness or sadness in her tone of voice and eventually she admitted socializing at her age was hard. I told her I saw some flyers in the lobby for knitting and book clubs and she seemed intrigued. Her doctor's orders/advice supported her participation in walking and other low impact occupations while her social life hindered it. Conversation was easier to maintain when we took rest breaks and she was focused only on talking. I pointed out things while walking, but asked questions when we stopped. We made it back to her apartment from our 22 minute walk and she immediately sunk into her chair. I asked what she thought about it and she said it was "worth the aftermath." I asked her how she plans to stay active and engage in meaningful activity despite her challenges, and she said she would look into book club because it's hosted right in the lobby. I think that walking interviews are a great tool in our field, but need to be used wisely and with safety/diagnoses in mind. If I had known sooner about her osteopenia, I would have offered to do something outside but less taxing or done more research on appropriate activity. I am grateful though, for the opportunity to help her get outside when she's going through a tough time, and for the memories I got to create with her. I think in future practice, it would be beneficial to get my patients outside while participating in an activity or offer to practice something like feeding and eating outside so that they know that life doesn't stop just because things change.