Thursday, April 05, 2007

Tying some loose ends

About a year ago I posted about the use of passive tactile sensory stimulation and the lack of evidence that we have about the technique. You can find more discussion on this topic by typing in "Wilbarger" as a search term in this blog or by going to this link.

In any event, I wanted to update a statement that I made last year that reads: While surfing around tonight I think I found a potential source of very useful information - and I think we might be able to thank Ruth Segal..." Dr. Segal did publish her article "Integration and application of a home treatment program: A study of parents and occupational therapists" (Segal & Beyer, 2006). This is an excellent article for all pediatric therapists to read. It reviews in detail the perspective of parents regarding home programs and the disconnect that sometimes occurs between the therapist's thinking and reality of normal family lifestyle. This article isn't directly assessing the effectiveness of a 'brushing program' but it does look at the issues of 'prescribing' a program that is potentially intrusive to a family's normal occupational routines.

Dr. Segal makes some critical observations including "Although therapists should continue to educate parents about this intervention, it is important that they keep in mind that parents' lives may not revolve around occupational therapy and the child who needs this particular intervention." The question then is: How ethical is it to prescribe some type of intervention program that is fundamentally disconnected and in fact is disruptive to the normal flow of activity within a home? One could argue that chemotherapy and radiation interventions for cancer are maximally disruptive to normal living - but then again the MDs who prescribe these interventions don't claim to care about lifestyle and occupational performance issues directly. As lifestyle and occupational performance are the bailiwick of the occupational therapy profession do we need to be more responsive to these concerns?

On a related note, the March/April 2007 issue of AJOT is chock full of good material that also needs to be discussed as it relates to evidence and sensory integration/processing - so please find your recent AJOT and read it - a few upcoming entries will be directly related to that content.


References:

Segal, R., & Beyer, C. (2006). Integration and application of a home treatment program: a study of parents and occupational therapists. American Journal of Occupational Therapy, 60, 500-510.

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