This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Saturday, 18 February 2012


Earlier this week I spent a second afternoon at Rancho Los Amigos National Rehabilitation Center (known to all simply as Rancho) with Michelle Berro, the OT Manager for out patients and Michal Atkins, a longstanding senior OT staff member who is currently leading the introduction of 4 new Lifestyle Redesign programmes.

 Rancho has a long history in the area, having originally been built to meet the needs of the many people who came to the area in the late 19th Century gold rush- but did not strike gold. There were high levels of destitution at that time and one of the Rancho initiatives was a 'poor farm' that provided employment and supplies. Later, major developments occurred during the global polio epidemic of the mid 20th Century. Latterly, many of the building have required extensive (and expensive!) 'retro fitting' to make them earthquake safe and so are now used as admin buildings.

"Patients made wicker chairs as part of the occupation therapy treatment to help increase strength, range of motion and endurance"

One of the old hospital corridors has a display of pictures from the old  days, including many of the occupational therapy departments and workshops of the time.

'Rugs made in occupational therapy provided the patients a great deal of pride and increased self esteem.

  The in-patient wing is now housed in the modern Jaquelin Perry Inistitute. There are about 150 beds. The out patient service for Occupational Therapy, Physiotherapy & Speech & Language Therapy sees about 150 patients per day.There are about 40 OTs employed.

Rancho is not part of University of Southern California(USC) Hospitals. It is a separate entity with it's own research and clinical programmes. There is close collaboration between the USC OT faculty and Rancho and Lifestyle Redesign has been a major part of this. Michal explained that she first used the approach for a contract from the Veteran's Association (VA) for patients referred with chronic pain, I found this very interesting as this week's reading for Lifestyle Redesign class is two recent articles in the American Journal of Occupational Therapy about the role of OT for people with chronic pain- more about this next week. The chronic pain intervention programme was very successful and the 4 areas that Michal and the OT service will now go on to develop are:
  • Traumatic Brain Injury
  • Spinal Cord Injury
  • Stroke
  • Neurology

 During my visit we had time for a quick look at the work researchers at Rancho are doing on shoulder pain and the effect of managing car transfers for wheelchair users. The lab has a car all fitted out with sensors to monitor where and how much leverage wheelchair users apply as they transfer themselves and their chair in and out of the vehicle.

The research team explain the project to Michal

My two visits to learn about OT at Rancho gave me further insight into some of the areas where Lifestyle Redesign is being used successfully in a setting that is not preventive, but is aimed at enabling people to regain a level of independence and to participate in meaningful occupation as part of the recovery process, often following catastrophic illness or injury, and to give them the skills to self-manage residual disability or chronic conditions and to promote health promoting occupational choices for the future.

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