Occupational therapy with the animated dead

1. Occupational therapy with the animated dead Gordon Muir Giles, PhD OTR/L FAOTA

2. A note on Terminology • Occupational therapists use APA non-handicapping language and as such avoids the colloquial and now considered pejorative “Zombie” and prefers “animated dead” • We would prefer to use person first language (but they are not people) • This term is consistent with the DSM-5 term for vampire of “undead” • Animated dead is currently only included in the DSM-5 as a research diagnosis included for further study

3. Learning Objectives After participating in this workshop the participant will understand: • Occupational therapy assessment principles applied to the animated dead • Occupational therapy interventions for the animated dead • Safety precautions and contraindications for working with the animated dead

4. Origins of the animated dead • In the historical past it used to be considered to result from voodoo magic • Now known to be the result of the improper disposal of radioactive waste or the result of viruses • Usually the result of government malevolence or ineptitude • Single case reports include parasitic origin (see “The Wrath of Khan”)

7. Diagnostic issues • Diagnosis of the animated dead is essentially a two step procedure • Dead or not dead • Animated or not animated

8. Occupational therapy and the animated dead • Occupational therapists strive to be client-centered, occupation-based and to use evidence-based practice. • Search of Pub-Med data base for “Animated dead” yield 31 citations and for “Zombie” (with the species filter “human”) yields 28 articles. • None of these are RCT and only 3 are review articles and these are reviews of lower level evidence • There is no specific occupational therapy literature related to the animated dead so that in what follows we are forced to rely on other disciplines expert opinion and single-case report.

9. Rating scales • Rancho Los Amigos Level of Cognitive Functioning Scale (Hagan, 1988): Level 4.The patient is very confused and agitated about where he or she is and what is happening in the surroundings. At the slightest provocation, the patient may become very restless, or aggressive. The patient may enter into incoherent conversation (only some viral strains).

10. Defining characteristics of the animated dead • Low (actually non-existent) blood pressure • Low body temperature (actually room temperature) • Hyperphagia (brains preferred, but any flesh will do) • Other symptoms vary by viral strain (see next slide) • Note the undead are also room temperature but they bleed (i.e., have blood pressure)

11. Viral strains • NLD Type 1* no language (grunts)1 • NLD Type 2 and 3 Limited language* • T-EDL 1 no language (grunts)2 • WDS 1, 2, 3, and 4 No language3 • WWZ 1 Collective action and attracted by noise, avoids sick people4 1Night of the Living Dead 2Twenty-Eight Days Later 3Walking Dead 4World War Z Known to say ”Send more paramedics over CB radio while eating the brains of a paramedic”

12. Occupational Therapy Assessment • Occupational therapists pride themselves on being client-centered and so the first step in the assessment is the occupational profile in which the goals of the client are assessed. • Goals of the animated dead are to eat brains – and other body parts limiting the need for assessment.

13. Occupational therapy assessment (continued) • Analysis of occupational performance. • Mostly limited to Feeding skills • Often hampered by food loss due to inadequate lip closure

15. Occupational therapy Interventions • Occupational therapist focus on ADL and IADLs • Feeding continued • As with other populations with significant neurocognitive disorder feeding skills are influenced by motivational factors. Persons with Major neurocognitive disorder will be more able to eat highly motivating foods (e.g., ice-cream, ethnically appropriate foods). • Animated dead will show the highest level of feeding skills when eating human brains.

16. Occupational therapy Interventions • Occupational therapist focus on ADL and IADLs • Areas where little motivation is evident • Continence • Dressing • Personal hygiene • Mobility (for gait see PT evaluation), but see cognitive skills later this presentation • Domestic skills

17. Cognitive skills • Like many individuals with major neurocognitive disorders the animated dead typically do not follow directions. • They will however follow you – often rapidly • Poor safety awareness is endemic with the animated dead – not so surprising since they are dead so it is unclear what safety means.

18. Clinical Practice Note • With zombies it is sometimes hard to maintain the focus on a positive therapeutic relationship, but it is important to remember that zombies “love you for what is on the inside!”

19. References Evans, R. G. (2006). Fat zombies, Pleistocene tastes, autophilia and the "obesity epidemic". Healthcare Policy, 2(2), 18-26. Lenaghan J. (1997). Zombies in the night. Nursing Standard, 11(40), 17. Nijsten, M. W., & Statius van Eps, L. W. (1984). The pathogenesis of zombies: Paranormal phenomenon scientifically explained? Ned TijdschrGeneeskunde, 128(51), 2412-2415. Palmer B. (2008). Snow White and the zombies. European Eating Disorders Review, 16(3), 245. doi: 10.1002/erv.874. Raspberry W. (1978). Turning patients into zombies. Washington Post, 11, A25. - Surely not peer-reviewed. Skokowski P. (2002). I, zombie. Conscious Cognition, 11(1), 1-9. Thornhill, J., Clements, D., & Neeson, J. (2008). Myths, "zombies" and "damned lies" plague Canadian healthcare systems: What's a researcher to do? Healthcare Quarterly,11(3), 14-15.