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Hi, I'm Kezia, a stroke ,survivor and a member of BIND.
And hi, I'm Carrie, a stroke survivor and a member of BIND as well. And today's guest is someone who is very special to me. You've all heard me talk in the past about how much my OT helped me get better and learn how to live productively with the lack of use of my left arm and all that fun stuff. But anyway, we thought a great idea to invite Alice Petranek, who is an Occupational Therapist with Rehab Without Walls, And on a side note, also one of the founding Board Members for BIND.
And so we just thought it would be fun to have her as a guest role here to help survivors get back behind the wheel. So welcome, Alice.
Thank you guys for having me. It's an honor.
Great. So, I know you helped me prepare to drive back. We said we were just talking about, you know, that was like 15 years ago. Yeah. Um, when I was still a patient. Can you kind of share a little bit about what the process is, For a brain injury survivor that is still in rehabilitation and wants to return to driving.
Absolutely. So as you know, OT works on all those fun things that we do every single day that most people don't even think about. You're bathing, you're dressing, you're getting yourself some food, taking your own medication, and mobility. And mobility includes not just how you're walking around or moving your wheelchair, but Transportation and, uh, driving is one of those activities of daily living. So, first and foremost, we're going to do a comprehensive evaluation.
Just depends on where you are in your rehab process. And we're gonna look at all the fun stuff. We're gonna look at how you're moving your arms as well as your legs. We're gonna look at your sensory. We're gonna look at can you hear things? Are you able to hear sounds? Are you able to react to the sounds when you hear them? We're going to look at how your brain takes in that information and makes sense of it. That's called our sense of perception. And together with that is our vision.
And that's a big one. Uh, vision is a huge determining factor in driving. And then of course we can't forget about our coordination. Our ability to work our hands and our arms together. Um, and our feet and our legs. To, uh, brake. To steer a car. To activate a signal, to turn off a radio. So, those are all the things that are part of our big OT evaluation. And, there are things that we can absolutely change in therapy, and those are the things that we focus on changing.
There are some things that are just beyond our grasp. Um, and obviously, vision is not something that we can change from the outside in. So, that's something that we can't always work with, but we can work together with. Some kind of a vision specialist, like a doctor. Also, if somebody has lost movement in one of their extremities, people think, well, I can't, I can't drive, right?
I don't, I can't use my right foot to, um, use the accelerator or hit the brake, or I can't use my right arm to put on my signal or turn on my wipers. Well, there's a lot of things that we can do to overcome those physical barriers. So that's all part of the OT process and we work really closely together with the rest of our team members to figure out how we're going to do that.
Yeah, I really like hearing everything that Occupational Therapy does because we've had other Occupational Therapists come in and we, we focus on something, something else like, um, Aphasia, or you know, how, what do Occupational Therapists do? But I think it's really good that you just said like on our everyday life, how do we get from point A to point B, whatever it is. I think it's really good to be hearing about that.
Um, and right now, like you were talking also about the evaluation that Occupational Therapists run, like to begin to drive, like, you know, I guess on your end it would be the evaluation, but as a survivor, like as a, as a patient at the time, um, in rehabilitation, when do you start hitting off the, alright, let's get back to driving? Like, do you, do you wait for, like, the motivation of the patient, or do you, Are you the one to bring it up?
That's a great question. Um, as you know, driving is a super complex activity. It just doesn't involve one or two things. It involves an entire gamut of abilities that have to work together in a way to make you safe and to make everybody else on the road safe. So, for that reason, most times, it's patient driven. Um, we never want to put somebody in a situation they're not ready.
Um, although therapists are notorious for pushing people beyond their comfort zones, that's where the real learning and the magic happens. But driving is one of those areas where it is patient led for most, for the most part. There's a lot of things that as a team, because none of us operate in a vacuum, especially when we're working with people who have had neurologic issues like a stroke. None of us could do what we do without our teammates, without our counterparts.
It is truly a comprehensive program. Um, so, I would never say it's the OT that decides she's ready to drive, he's ready to drive. We need to start working on this. It's really a team approach, because my counterparts who are in speech, who are in physical therapy, who are counselors, who are neuropsychologists, um, all those team members, Custom words are seeing so many different facets of what you're doing, and how you're doing them, and how well you're doing them.
And they're also noticing where you're still having issues and where we may need to focus on. So, it's a team approach for when you're ready, but we usually wait until the person is showing those signs of independence. And in the perfect world, they will match up where we think you're getting to that point, and you start to decide, hey, I think I'm ready to go to that next level. It's a complex answer, but it really is very simple. In the end, it's patient led. Therapist driven.
Yeah, I think that's true. And I think we were just talking about before, before the cameras turned on, we were talking about the, you know, I look pretty normal and I have like the ability to move and I don't have, um, mobility, uh, limitations. But I think mentally I wasn't ready to drive and I think that I would have been overwhelmed if I was like, and I would get overwhelmed by my family, like, but you're okay, you're okay, you can do it, you're fine.
And I would be like, I felt like, very responsible if something were to happen. And I think that that's important to be feeling ready and having, feeling um, I guess empowered and like comfortable saying like, I'm not ready. And trusting the Occupational Therapists to be along your side, right? And I think that's important to hear.
Absolutely. And Kezia, you just brought up such a wonderful thing and in the therapy world we have our words and that word is called insight and that is such a wonderful thing to have. Nobody knows what you're walking in, what you're experiencing other than you and if you the person who is walking and talking, living and breathing in your new body after your stroke feels like their confidence isn't ready. That is the person that we should be listening to the most.
Yeah. Um, as you said, it is an overwhelming thing. There's a lot of things that have to happen for you to turn that key. Or, in these days, press that button. And put your signal and just get out into the world. Um, there is a huge amount of independence that that brings, but it also brings with it a tremendous responsibility. And I'm so glad that you are aware of the insight that it takes to know I'm ready to take that on.
Yeah, yeah, thank you. Thank you.
And I'm a little bit of the opposite of Kezia. I started working on everything in therapy. And I really wasn't that worried about my left side not being able to work. I felt good with that. My biggest concern was just my left neglect. So I didn't actually try to start driving until I finished therapy. And figured out, you know, let that kind of, it took a couple of years for that, for me to feel comfortable enough that, Okay, maybe.
Maybe I'm not going to hit that left curb when I'm driving, or I'm going to be able to turn correctly. So, it's all a little bit different. But, so that, I mean, that, that was going to be my next question. Like, there are barriers. And we talked, you talked a little bit about them. The mobility, the vision, um, there's cognitive, there's aphasia, I mean, there's so many different things that cause So many. Um, so, I mean, how do you work with all of those together? I mean!
Um, it has, it's timing. Um, I think you hit the nail on the head when you said you had to wait a few years to figure out when it was the right time for you. If somebody is experiencing the cognitive, the physical, the visual, and then the concept of overstimulation all at the same time, it's really hard because you do need to address each one of those things. It's like an onion. You have to peel away those layers. Um, Um, you learn to live in that new body. You learn to use filters.
You learn to control your environment. Hopefully, you're doing that in therapy, and you're learning your strategies. So trying to do all of that at once is an overwhelming task, and I don't, I don't advise that for anyone. Um, but when you do come down to it, you're probably gonna have to manage just one or two of those things. And I think by the time you are ready, to take that test at DPS. Um, you realize that the vision had healed and you'd learned a lot of strategies on scanning.
Maybe gotten some really good mirrors adapted into your vehicle. Um, because you didn't need them, but some people may. Um, and the physical aspect, I will say, Excuse me, it's spring in Texas and my allergies are in full bloom. Um, in, in the state of Texas, we have, um, just a regulation that says you have to retest after you've had a stroke or some other type of injuries. So, when you are basically getting into that car, for you, it's, okay, this left side.
It's so much easier to get over a physical impairment with so many modifications than it is to get over something that people can't see, that unseen injury. Um, and that may involve a lot of other things. So you were fortunate. Um, Kezia's situation, very different. Right. But she has the insight to know when she was ready and when she was ready to approach that. So, yeah, a lot of obstacles and hopefully we can pare away some of those before you even start to approach.
The actual drive, return to driving process.
Yeah. And right now I, I liked what you were just saying about the unseen, right? The unseen injuries or brain injury. Um, that was actually something that I really wondered is just like as an Occupational Therapist, like how is it to be working on like the cognitive issues? Um, like, um, to be able to go back into driving. Like, what are some strategies for cognitive, um, like difficulties on, yeah, on how to go back.
So I love a good brain game like anyone else. Um, at the clubhouse, you guys play a lot of really good stuff that hits a lot of those cognitive areas that are important. OTs are notorious for structuring activities where you have to, um, Not just pay attention to what you're doing, but kind of either also pay attention to something over here, or filter it out. And what's your success in doing that? And those are really fun things to do.
But the reality is that when you're ready to start driving, there's nothing that's going to ever take the place of real world driving. So the best form of getting ready to drive is professional led driving therapy. And every individual has a very different presentation and hopefully the OT that you're working with at the time can guide you towards what that is.
It could be from a community based driving school, if that's the level that you're at, or it could be working with a Certified Driving Rehab Specialist that sometimes is also an OT. It's just another level of OT. Um, but if you're talking about just your regular OT, We can do a lot with you in the car, as long as we're not moving that car. So, um, for somebody like Carrie, maybe we go in and figure out, Okay, we need to figure out how to adjust your seat. You need to be able to adjust your seat.
Can you do that by yourself? Can you get your, your, um, seatbelt on? Are you able to access your dashboard and everything you need to do? You know, where the controls for the windshield wipers are. Sometimes those things have to be relearned. Um, from an accessibility point, like I said, we can modify a vehicle in a lot of ways. Um, but when it comes to the actual task of driving, nothing will substitute real life driving. And I have a small caveat to that.
Some programs, if they're big enough, um, have driving simulators. And I think Carrie had the benefit, um, of using a driving simulator when we work together.
We did, and I did not like it.
Of course not. However, if you have it, it is a wonderful way to, as a precursor to the real on road stuff. And some people need a lot of time on those simulators if they're lucky enough to have them around. Um, but like I said, driving, there's really no, substitute for the skills of driving, then driving itself.
And like you said, I didn't really like the simulator. I hit a lot of cars on the left hand side when I was doing the simulator. And you're right, I did not, and I've mentioned this in one of our other podcasts, I think with Brandon, I did not want to get behind the wheel with Dad. I didn't want to get behind the wheel with Dad when I was 15, I didn't want to do it when I was 38. So, yeah.
So I did, I just hired, there was a driving school around the corner in The Colony, so I just, We hired them for like two weeks, you know, not, not full two weeks, but you know, we drove around The Colony a couple of times, a couple of days, you know, for an hour or two at a time. And then, um, you know, we drove down the freeway, we drove from The Colony to Grapevine and back. Again, that was for my benefit, for the love and the gut, to make sure I could do it before I went back to DPS.
Take a quick little break. Of course. And remind our listeners to go ahead and click that like button. Click that follow button. And if you're on YouTube, click the notify button. Click all the good buttons. And so, but so my question then was, um, I remember as well when I was, when you were helping me, that we reviewed all the, even though I didn't have to take the written test, we reviewed all the written tests, we reviewed all the traffic rules, You know, what's the yield, what's the stop?
What's, you know, so that, that's part of the normal process for OT as well.
Absolutely. Um, one of the reasons I love my job so much is because the scope of what I do is just immense, and it could be as broad as I want it to be, and I love that because I get to tailor it to what my patient's needs are. Um, I don't know too many jobs that let you do that So with us. That was your goal, so that was my goal. And we took that very seriously.
We had driving manuals, we had sample tests, in case, um, I think at that point, there were certain instances where DPS was asking, um, individuals who were survivors to not only take the on road test, but in certain circumstances, if they couldn't verify their, ability to comprehend directions. They would ask them to take the written test and we didn't want to take any shortcuts so we took it very seriously and we went through every single one of the road signs.
We went through all of the traffic laws and it was a good reminder for me because I was new to the state at that time and not the same laws in every state so that was kind of interesting. So 100 percent part of an OT program.
Yeah, and again, I'm just really liking how you're being very detailed about how Occupational Therapy is so broad, right? And then at the moment, we're doing, going back into driving as our main, like, our main, our topic, our, like, our conversation.
But going on with that, like, how would you be giving the advice to family and caregivers who are the people that are supporting, you supporting us that aren't going to rehabilitation, you know from the whole day or for Inpatient they're not there all the time. But what would you be sharing to the people that are there supporting us and how they can support us to on going back into driving.
We live in a society and we have friends and families that have opinions and they want what's best for you and that doesn't always line up with how you feel or maybe where you are in your rehab journey. Um, with driving, and I've said this several times now, the most important thing is safety. Your safety, um, and everybody else's safety. So, having a conversation with your Rehab Professional.
Instead of relying on just what you're telling them, if they feel uncertain, that maybe, Oh, maybe it's just Kezia. Maybe she just doesn't realize that she's capable. Rather than frustrate the person, have a conversation with their therapist and see what the therapist has to say. I've found that a lot of times there's just a miscommunication. People are missing each other.
Their coming, family may be coming from a place of support, wanting the best for you, wanting to see you walk farther along down that path. And what they may be missing is that thing that we talked about. Oh, but she looks so good. Oh, but she, she's almost exactly how she was before. And I call, we call it the unseen injury.
They have no idea the filters that you have to build up on a daily schedule to be able to get from point A to point B. Uh, I think one of the things I think is really important is that you have to be able to pay attention in a conversation, um, startled from noises that are unexpected, being able to control your reflexes when you're nervous, when you're overwhelmed, the frustration of 635 traffic, um, all of those things.
And I, I, I find that most times if your loved ones can have that presented to them in a very caring way, I think that usually kind of solves that problem.
Yeah, I think so too. I actually, I feel very blessed that I had rehabilitation, like inpatient rehabilitation and in a place where my family and friends were included in the conversations because I was not able to communicate at all. So, They had that root of like, okay, they need the support. I can't assume that she gets everything right. And there are people that don't.
So that's why I find it so important to get people like you on the podcast, you know, As an OT education is such a huge part of what we do. And that education just doesn't involve the patient therapist relationship. It does involve your family, your loved ones. There are times and instances where I have the privilege of helping somebody find a volunteer position. Um, as a stepping stone to possibly going back to competitive work.
It's part of my job to educate wherever that volunteer position is going to be that these are the circumstances and I want someone to feel empowered in their new position. That means I need to educate whoever it is that's accepting that person's volunteer position or even employment, what the parameters are, and how to create an environment that is successful for you.
So education is such a huge part of it, and I would hope that in any situation where we're talking about something so significant that involves so much safety risk, that we are educating at nauseam.
And that's why we're having so many episodes on driving, because it's one of the main things, that, brain injured survivors to want, because that is the final step of independence in life. For me, it was like, I can leave the house when I want to, I don't have to have my parents take me somewhere.
So I have, um, one other question, um, I don't think there was, or I didn't think to ask back when I started driving, but are there any, um, What kind of programs or funds, like, grants that people can apply for if they need help modifying their vehicle?
Yeah. Great question. Funding is a huge part of return to driving if you do need any kind of modification. There's nothing that provides a new vehicle that I'm aware of in the state of Texas, but there are situations where Some state agencies can provide some funding, such as the Texas Workforce Commission, if you are a member and have an active case, they can help you fund the modification. So, sometimes it's, um, hand controls, sometimes it's a drive up to the modification.
The actual steering wheel, ramps, um, and I would always say, work with your local or available social workers, they are a fund of information, they have resources, sometimes that I've never heard of, in terms of what's available and what's not, because it is constantly changing. Um, and if you're a veteran, there are situations where the VA or some affiliate programs of the VA can help, with extensive modifications and they just need to know who you are for those funds to be utilized.
How do you find your local social worker? Well, I mean, I know I live with one, but
That would be a great interview to have. So a clubhouse like this, like BIND, usually has a lot of individuals that have worked in rehab for many years and they have a lot of different connections in the, in the community. If not, um, through your own county. So your Collin County office, your Denton County office. I believe every single one of the counties has to have a designated social worker. So you can go through that way.
Or, if you have a, maintained a good relationship with your rehab professionals during your inpatient stay, there's usually always a social worker on staff at the hospital. And they're more than happy to provide you with, they probably don't have the time to do the running around for you, but they can definitely point you in the right direction of the resources.
And I think I just found the new podcast idea. Yes. So Alice, I want to for joining us. I want to thank you for being in my life for 15 years and helping me become the person I am today from the person I was when you first met me. And again, thanks to all our listeners for listening. I hope you continue to listen.
Yes, and I want to thank you, too. It was a great conversation, and I hope everyone thinks that as well. And for all of you that have any, um, Any wants needs for different types of podcasts, you can always contact us at bindwaves@thebind.org. Follow us on Instagram, check out Facebook, your YouTube channel, all of those, and you'll be able to find us. Our website is thebind.org hashtag slash, there we go, bindwaves.
And if you have any And if you're interested in becoming a member of BIND and Brain Injury Network, you can always check us out and be part of the podcast.
And again, I want to thank you all for listening. Don't forget to click that like button, that share button, that notify button on YouTube. And again, remember, you want to watch on YouTube, because then you get to see all our pretty faces and the pretty faces of our guests. And so just remember to click all the good buttons that are out there.
Yep, and every Thursday you'll be able to see the new episodes on all of your favorite platforms. So, until next time.
Until next time.
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