Ep8 Fascia Science in Acute Care with Dr. Suzanne Holm

Welcome to the FASHA informed therapist, the essential podcast for occupational therapy professionals looking to deepen their understanding of FASHA's pivotal role in therapy and health. I'm your host, Amy Mayer, an experienced occupational therapist, practice owner and dedicated educator. Here we'll dive into the fascinating world of FASHA exploring its significance in the human body and its critical influence on occupational therapy practice. Each episode will bring you cutting edge insights, expert interviews and practical strategies to help you confidently integrate the science of FASHA into your therapeutic approach. Whether you're a seasoned practitioner or just starting out, our goal is to equip you with high quality, evidence-based and FASHA informed, continually education opportunities that will enhance your skills and benefit your clients. So join us as we unravel the complexities of FASHA and transform the way you practice occupational therapy. All health and wellness practitioners are welcome. Let's learn, grow and evolve together. Hi, this is Amy and this is another edition of the FASHA informed therapist. And I'm super excited today because I have my dear friend, Suzanne Holm here, to be on the podcast with me and you'll soon find out exactly why. Hi, Suzanne. Hi, Amy. It's great to be here. Yes, Suzanne is in town for Creighton's graduation. So tell them a little bit about what you do now and how we know each other. Okay, I can do that. I am an occupational therapist, clinically worked in inpatient rehab and then acute care, but I always wanted to be in the academic setting even when I was in OT school. And finally about 10 years ago, that door finally opened and so I'm at Regis University in Denver and I'm the academic program coordinator to oversee Creighton's Doctor of Occupational Therapy Program, the Regis pathway. So I'm the on-site coordinator and you and I know each other because I went back to Creighton University to get a post-professional doctorate and you were one of my amazing faculty and then you and I got to work together because you were the Regis pathway coordinator on Creighton's side. So we have a long history together. Yeah, and I actually, the only reason I took that job was because my daughter lived and her husband lived in Denver at the time and she was pregnant and I'm like, I'll do that job so that I can go out to Denver more and be able to visit my daughter and her growing little family and I did not even anticipate that creating that program with you would be one of the most fulfilling experiences of my entire academic career. It was super fun. And in the interview process, I thought hard for Suzanne to be the on-site coordinator because I had her for class as she said and I remember commenting on one of your papers like, oh my gosh, this is the best thing I've read and it was such a long time maybe ever. So I knew the quality of work that Suzanne could produce and yeah, and it was definitely the right choice and the Regis people have said that to me many times. I'm so glad you've fought so hard for us because it was totally worth it. So awesome. Okay, so anything else you want to say about what you do now? I mean, I feel like it's just like the best fit for me being Regis and Creighton and really helping to grow students in sort of that, I don't know, Jesuit education and pedagogy and really trying to help them have a heart not just for the profession of OT but for their future clients and patients and really to meet the world's needs. Yeah, oh yeah. It's been really fun even though I've been out of that for five, six years now but I still keep an eye on where the students are going and what they're doing and see things on Facebook and Instagram and it's just, it's so cool. But this podcast is about the fashion and form therapy. So another side gig that Suzanne has is she's co-editor of a textbook and you want to explain the name of the textbook and kind of how you got involved in this textbook. Sure, I'm happy to. The textbook is Occupational Therapy in Acute Care and the first edition came out in 2011. The textbook was the brain child and visionary work of Helene Smith-Gabai and Dr. Smith-Gabai was a acute care occupational therapist and she had gone back to school originally to get her clinical doctorate and later went on to get her research doctorate and she really wanted a textbook written by Occupational Therapy Practitioners for Occupational Therapy Practitioners in Acute Care. Like that was just sort of like her passion. So it came out of part of her academic work but took, you know, I don't know. A textbook takes a lot of blood and tears, takes a while. So I don't, I can't even now remember maybe when she started on it, maybe 2007, 2008 and she and I had known each other through serving on a committee with AOTA and I had reached out to her sort of spontaneously. I had had a bad ski accident and fractured my leg and was recuperating at home and couldn't work in the hospital at that time and I just chucked in with her to see sort of what was going on and she's like, "I'm working on this textbook and, you know, are you interested in, would you, you know, maybe want to be an author of a chapter? I've got some chapters that I'm looking for authors for." And so that sort of just got my foot in the door. I didn't know that how to do it or that I would sort of enjoy doing it. But it's been a super great experience. That first edition went to publication in 2011 and then AOTA Press picked it up which was just like fantastic. They'd take a chance on this book and became a resource that maybe was used beyond what Haleen had originally thought it might be. Like I think her original thought was it'd be used by occupational therapists that practice any acute care but sort of academic started using it, students started using it. So I ended up having a bit wider audience, I think then she originally intended. And so when it came time for the second edition to come around and that was published in 2017, she asked if I would want to be co-editor as well as do some of the chapters and co-edit the book with her for sort of like the vision, the process being organized, making sure like the chapters are looking good, have the right content, are going to support excellence in practice and acute care. And so for some reason I've said yes to that as well. But excitingly it's time for the third edition to come out and we just finished submitting all of the chapters and they're sort of the term is type set but they're not really type set. It's sort of like the final proof for when they go off for a print. And so we're hopeful that this third edition will come out this fall. Excellent. Yeah, super excited. So now let's talk about, was it a year ago? I think it's two years ago. Two years ago. Two years ago. When we were sitting on a plane to I flew to Denver and then Suzanne and I then had the same flight to San Antonio to go to AOTA and Suzanne probably asked me a very innocent question like what you've been up to. And so I take those opportunities to start talking about my practice and fascia and at that particular time some other resources said come out about fascia and I was just non-stop talking and Suzanne is an excellent listener and an excellent questioner and which makes it really fun to talk to. So I started just telling her all about the science that was pouring out on fascia and how I was using it and how it was making such a difference with my clients and educating them and teaching them skills and I had no idea that you were working on the fascia. The next edition of this book but then you said. I'm sure it was something along the lines. that this kind of content could be really important to you acute care occupational therapy practitioners. And they need to know this information. And so, as you had explained more of the science and about fascia and as part of an essential body system, I'm sure I was like, why couldn't we offer this content in this textbook? And let's get the word out and make sure occupational therapists have the best information available to be able to do the best kind of treatments and really help the patients on the other end. Exactly. And I'm sure I was saying, oh, fascia is now considered to be a body system and it's not just a body system, but it's actually the environment of all our other body systems and your textbook has a chapter on all the different body systems. So at first we were like, we need a whole chapter on fascia because it's a body system and you're like, well, let's see what AOTA says we have room for because it's already a pretty massive textbook. Yeah, it is like a door stop. Yeah, it's pretty thick. But there's another section on disorders and conditions, management and one of the chapters is on pain management. And that chapter was going to get pretty heavily revised for this third edition by one of the co-authors, Megan Doyle, who's an occupational therapist that has extensive experience in pain management, including pain management in acute care. And I think in tucking with Palin and AOTA press we were like, maybe we can get this information about the fascia system incorporated into the pain management chapter. Maybe it can stand this year, this version as an appendix and really provide some of that like initial information to get therapists thinking about, oh, either what is this or tell me more about it or I want to know more about this as a way to maybe is a first step address people's pain because in acute care a high percentage of patients that we see have pain. And a huge barrier to participation, right? Right. I've spent quite a bit of time in acute care and used the multifacial techniques but didn't have the science at the time to back all that up or add all the other things that I do with clients now in acute care. But yes, it ended up being an appendix but perhaps the longest appendix in history. I think it's like 20 pages. I can't remember now from the typeset version. It may have been in the word document like pretty hefty appendix but I think the hope is if there is a fourth edition if that is an option that perhaps it could be extended. In the way that I would want to expand. Yes. Okay. So the appendix will probably look much smaller in the actual book itself. But it includes, it includes the basic science of what the fascia system does in the body and all those different things. And then it covers a little bit on mouthhashel work and different kinds of mouthhashel work and what it's intended to provide and how the science is currently supporting it. There's of course a whole lot more to be done. And then there's suggestions on how an acute care therapist can use it. And I remember the first version of my appendix that I sent to you. Suzanne is an incredible editor and she made so many wonderful suggestions and it's reorganized. We completely reorganized pieces of it in order to make it flow better. But and you really wanted the emphasis on how can acute care therapists use this content? And do you want to talk about that at all? Well, I think you might be really good at talking about this because I feel like even when we have a conversation on the plane, you know, and as you and I have talked before, if you are trying to engage someone in the therapeutic process and they are resistant to sort of traditional approaches, you can use sort of, I don't know, this engagement of them through either addressing their pain or helping them understand how they might move better or engage in occupations easier as like this gateway to get into them through facial work. And there's so many, like I know you can speak to this more, but just like helping them do some of the techniques even for themselves. Like the self treatment. The self treatment, I think, can be a way in and it's in your appendix about this can be part of that therapeutic use of self, that occupational therapists are an occupational therapy practitioners. It is so essential to our practice and helping make that connection of trust between the practitioner and the patient. Yes, it's the way that I see it is this whole other layer of science that we have in understanding the human body now. And especially its intersection with understanding pain. It's a whole other way to, an education is so important in all settings, but in acute care in particular because we're trying to give them information to get them safely out of the hospital, right? And not have read missions and to be safe at home. Yeah. So it's a whole other way of talking to them about their body and educating them. And when you start to learn about the science, it's a very, it's very empowering information. It, it, it's all about how what they can do to help their body in a way that they can understand how changing your breathing or changing your posture, changing your positioning or letting a little more movement can make this massive difference. And we tell those, tell people those things all the time, but we don't always have a good explanation of how and why it helps. And the fashion, the fashion science gives us that. So yes, it's a way of, did you know or have you ever heard about your facial system? And enough people are hearing about it from different avenues now, but they might go, yeah, what is that? And they might, it's, they might be curious or I'm offering them one piece of information like, well, did you know that your fascia has eight to ten times more nerve endings in it than your muscular system? That usually makes people go, oh, oh, is that why my hip does that? So it's, it's a way to get them engaged to build rapport and then offer them something that, hey, you know what, if you transfer over to this chair, I could do this technique on your shoulder. And that might make it easier for you to get up and hold onto your walker. And then, you know, you've got a, you've got some education in, then you've got a transfer in because you had, you know, you'd encourage them to get to the chair. And then you did this, this shoulder release on them. And then they're looking forward to you coming back next time. And then you've, you've got your productivity in and they're looking forward to coming back. Your refusals will probably go down. I mean, and then the self-treatment portion is another. I mean, you keep a tennis ball in your pocket or a therapy ball better yet. And well, I need you to come over and stand by the wall here. I'm going to show you how to put this ball in your low back between you and the wall. And then you've got another, you've got a transfer. You've got some gate. You've got, you're working on, you can work on posture. There's just so many ways you can weave this in to get somebody moving. And then, you know, they can learn how to better manage their own pain. I think also it helps them to more easily engage in their normal day-to-day routines, right? The occupation focus, whether it's absolutely. Getting a shirt on or doing their grooming routine at the sink or taking care of their needs in the bathroom. If you feel better, you're going to do all that stuff. But a lot of the techniques in the mouth-fuscial world are also aimed at improving mobility and range of motion in the joints. And if you help somebody's shoulder joint feel better and move better, then they are going to be more willing to do those occupations and more comfortably and more effectively do that. So, so yes, Suzanne, let me write this and I think invited you to write this really a critical piece of work to go in this textbook. And thank you so much for being open to it. And she's sort of got this confused look on her face right now. Like, why wouldn't I be? And I guess from the perspective I have, part of my mission in life is trying to get other therapists to listen to what this, I think we have a responsibility to continue learning, right? And to stay educated, that's what continuing education is all about. And that's why we have it built into our license, sure, is it? So we stay current and we continue learning and patients get the best possible safest care. That's what CE is really all about. So trying to get, and in the world, the massive world of continuing education out there, how do I get therapists to listen and say, and to that this thing about fascia is important? I think part of the barrier is there's a lot of old information about fascia out there or people only, therapists, practitioners only think about fascia in the context of pain management when it's really so much more and its proprioception, its interoception, its coordination, its energy storage. It's so much more than that. It really could be woven probably into a lot of chapters, in a lot of textbooks. So I'm excited that this is the first opportunity to get it out there on a bigger scale. How, you said it, therapists purchase it, but. Yes, we have universities too. Universities, some faculty, some programs have the textbook as part of like a requirement for their course. Students are sort of a big audience that we appeal to. We have an international readership, especially in some of the Nordic countries have been interested in the first and second editions. So we're hoping the same for the third edition. I think because the majority of the chapters are written by current practicing occupational therapy practitioners, although we've brought in some academics, we have a pharmacist now who has written a good percentage of the pharmacology chapter. I think in addition to having a lot of like evidence-based practice, a lot of it also comes from a little bit from the lens from the practicing therapist in acute care, or the practitioner in acute care, right? So it becomes very a practical approach, and it's pretty comprehensive. I know sometimes you can't add without taking away, but we've added maybe seven or seven more chapters in addition to your appendix. There's a new chapter in there called the novice in acute care, which I think could be really appealing to people that are transitioning into acute care practice, or maybe don't work full-time in acute care practice, or students on their field works might be really interested in that chapter to sort of frame. This is sort of the knowledge base and the skills and the things that I need to be checked off on for competency to be an effective and efficient and ethical practitioner in acute care. So I really feel like the the facial appendix is going to be like another sort of like highlight for this book to be like, yes, this is also in the realm of occupational therapy practice and what we should be doing for best practice with our patients. And I love that you said earlier, like, you know, so much of the emphasis acute care is very expensive, right? And so we really want to try to minimize these readmissions and occupational therapists in the practice of occupational therapy has outcome support to say that our interventions and our recommendations and our discharge planning can help reduce readmissions. And so I think having therapists have another avenue to say when you discharge from acute care, here are some additional avenues that you can pursue to help you be healthy and well. And that might be seeing someone in outpatient or in a private practice for my emotional release. Instead of just being like, well, I think you're mostly okay. So go home, you know, go back to whatever it was that you were doing before it. Like why aren't we helping people not just like improve, be able to leave the hospital, get home and stay home, but why aren't we also thinking proactively, how can we improve their health and longevity, long term? What are the recommendations can we make that are going to be critical for them? I mean, I think most occupational therapy practitioners have a big heart and really want what's best for their patients and their family members and their loved ones. And so maybe even if it's not for the patient, maybe even like, you know, for the patient. But for the caregiver. Yeah, absolutely, right? Yeah. The other thing I think about people in our profession too, besides the big heart, is a very openness to learning and having a big, I love the breadth of OT, having a big toolbox of things to reach into. And I think the fascia piece, the science, the techniques, the fascia wellness pieces that I talk about offer us a huge toolbox and the educational pieces to support. At least like I said, I find that that educational piece, my clients really latch onto and it makes sense to them. And to me, it makes it fills in the gaps of understanding how the body works and how it moves. So anyway, yes, I'm hoping that I would love to see our profession on the cutting edge with this science so that we can continue to do that amazing work that we're now scientifically supported in a acute care setting that our work is incredibly meaningful and effective with those patients. Is there anything else you'd like to say before we wrap up? Dr. Holm. Dr. Mayer. It's exciting, right? It's exciting to think about like other ways to get this information out there and I'm really hopeful that the readers of the textbook will, I don't know, be super curious and want to learn more about the facial system. So I think I'm fake. Okay, so there's like 47 chapters. So I'm fake, trying to remember. But I feel like you had some resources in there. But if therapists who or students who have the textbook or educators who have the textbook are interested in finding out more, where do you recommend, who should they reach out to in addition to yourself? Oh, more than that. When they should see me. Yeah, well mainly you, right? My phone number is, just call me anytime. Call or text. Start with the website. Oh. Form.com. Okay, great. Fashioninformed.com. And then my contact information is on the website. But the website will direct you to all kinds of different resources. Yes, the appendix has, I don't, a zillion references in there that you, that therapists can look up from scientific articles to other books that that fashion researchers have authored themselves. So there's a lot out there. There's a lot of resources available. But I am also always looking for collaborators to think about how this science fits into. Different areas of practice. So I just, it fits anywhere, it fits everywhere. It's part of our body. It's part of what we, it's another layer to our thinking. So okay, that's probably a good place to wrap this up. So thank you, thank you so much for being willing to do this on your trip here to Omaha and just have this conversation. It was, um, it was actually Caitlin's idea to, why don't you? Give you this amazing woman while she's here and I'm like, duh, why didn't I think about that? So thank you, Caitlin, for suggesting that and thank you Suzanne and, um, thank you for listening. Thanks for having me on, Amy. It's been a lot of fun. Yeah, it has. I love you. I love you too. Thank you for tuning into the Fashion Inform Therapist. It's been a pleasure sharing insights and strategies to help you integrate fashion science into your practice. I'm Amy Mayer and I hope today's episode has inspired you to explore further and take your therapeutic skills to the next level. Remember we're committed to creating and providing top notch evidence-based fashion form, continuing education that empowers you as an occupational therapy practitioner. Stay connected with us for more enriching content and don't forget to check out our online courses to deepen your expertise. Until next time, keep expanding your knowledge, refining your skills, and confidently applying the science of fashion to your practice. Here's to advancing together in health and wellness.