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Showing posts from 2008

Empirical vs. innate knowledge in sensory integration

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I received an email from the Sensory Processing Disorder Foundation about today's NY Times article discussing the process of how disorders are included in the DSM.

The email expressed excitement that awareness of sensory processing disorder was growing. I think that awareness of any problems that children have that can impact their ability to function is good - but I remain unconvinced that we are anywhere near ready for DSM inclusion of sensory processing disorder, if such a unitary disorder even exists. I have blogged about this topic before here.

As the title of this entry suggests, my primary sticking point is the problem of empiricism vs. innatism. Empirical analysis suggests a process where there is NO prior knowledge and everything learned is written upon the 'blank slate' of consciousness. One could argue that the seedwork of sensory integration research completed by Ayres was the closest that we may come to a truly empirical approach to the issue of sensory inte…

Assistants, aides, and the importance of certification

We have been advertising for physical therapist assistants recently, and I have been a little shocked at the high volume of calls we received from non-licensed people who believe they are qualified for the position. It is quite common to hear callers state "Well I worked as a physical therapist assistant and am not licensed but I am qualified for your position." I have never received similar calls when we advertise for occupational therapist assistants.

New York State regulations that govern PT practice on this issue are quite clear. They state:

New York State law restricts the practice of physical therapy to licensed physical therapists or certified physical therapist assistants. Individuals who are not licensed or certified may not provide physical therapy services. Aides may perform non-patient related activities such as secretarial, clerical and housekeeping tasks. Additionally, aides may act as an extra set of hands for the physical therapist or physical therapist assi…

HIPAA and FERPA: The opinion of a street level OT

I am not a lawyer, so stop reading my opinion and go talk to one if you are having a real problem. Please.

But here is my OPINION that I want to rant about:

Everyone needs to go and read the recently published Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) and the Helath Insurance Portability and Accountability Act of 1996 (HIPAA) to Student Health Records.

This is the most recent guidance document in a string of legal opinions and guidance documents that have been kicked around since HIPAA came into effect and schools were left trying to figure out what it meant. The bottom line problem is that we have created a system in the United States where a public health program (Medicaid) morphed into a broad funding stream for a variety of educational programs. The original stated purpose of Medicaid was for medically based interventions (and thus its common designation as a 'health insurance' system of sorts) - except that now it also pays…

Reading recommendations...

I have been absent for a couple weeks - immersed in important tasks that precluded my writing. While 'away' I did quite a bit of reading and so want to share some of my recent perusal.

1. A great blog post was brought to my attention recently. This should be required reading for all OTs... Emily writes in 'A life less ordinary' about "To OT or not to OT." Don't stop at that one entry - keep reading. This blog is so full of excellent writing and parent perspective that it will keep you busy for a very long time.

2. Connor Gifford is a young man who has Down Syndrome and he co-wrote a book entitled "America according to Connor Gifford." This book has a clarity to it that is difficult to find in writing about historical events. Go buy it. Today.

3. Ori and Rom Brafman wrote the book "Sway: The irresistible pull of irrational behavior." This entire book is fascinating, but OTs will be particularly interested in the chapter on 'th…

On the occupation of blog editing

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I get dozens of emails daily from readers and I generally enjoy them all. I try to respond to most emails.

Sometimes I get comments directly on the blog but those are more rare. I guess that many people prefer anonymity and that is fine.

Many of the comments are from anonymous people and I am frequently torn about whether or not I want to advance their comments. For example, someone may agree or disagree with something that I have written and they want to advance their own opinion on it - but they don't want to put their name with their comment.

This is easily fixed by disabling anonymous comments but some of the most thought-provoking comments are anonymous. All my life I have been fascinated by anonymous self expression - like carving into picnic tables or graffiti or on publicly posted leaflets or pamphlets. That is a topic for another day.

Many of the comments that never get published here are links to people's proprietary websites that sell products and I never wanted m…

Auditory interventions - a trip down the rabbit hole

I posted two and a half years ago about problems with a lack of evidence for the Wilbarger intervention methods. In that post I included a link to http://www.sensorydefensiveness.com/ which at the time was allegedly sponsored by Pat Wilbarger. Now that website curiously redirects and links to a mirror page for Valerie Dejean and The Spectrum Center, which is now located in New York. Apparently they used to have a center in Maryland, but according to documents from the Maryland Board of Occupational Therapy Practice, it is a matter of public record that a Valerie Dejean surrendered her license to practice for several reasons including:
use of the Tomatis Electronic Ear which has been banned by the FDAuse of unlicensed persons to practice occupational therapyfraudulent billing practicesI previously wrote about concerns with the Tomatis program and the FDA ban here.So in summary this Tomatis progam is not generally accepted but some occupational therapists continue to flirt with these pro…

Public Law 110-374 - The Prenatally and Postnatally Diagnosed Conditions Awareness Act.

Abortion rates of children who have disabilities are high, in excess of 90% of all pregnancies of children who have Down Syndrome (Mansfield, Harper, Marteua, 1999). In consideration of recent conversations here I think that it is critical to highlight the passage of a new law. Public Law No: 110-374 is called the Prenatally and Postnatally Diagnosed Conditions Awareness Act. It is the purpose of this Act to--

(1) increase patient referrals to providers of key support services for women who have received a positive diagnosis for Down syndrome, or other prenatally or postnatally diagnosed conditions, as well as to provide up-to-date information on the range of outcomes for individuals living with the diagnosed condition, including physical, developmental, educational, and psychosocial outcomes;

(2) strengthen existing networks of support through the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and other patient and provider outreach prog…

Sensory processing characteristics of adults who have complex regional pain syndrome

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I. Literature Review

Introduction

The purpose of this project was to explore complex regional pain syndrome (CRPS) by using current models of sensory modulation disorder (SMD) and by using narrative interview. Sensory processing theory as grounded in sensory integration theory (Ayres, 1979, p. 5) and later modified by Dunn (1997) provided the background neurophysiological models for this study. Dunn stated that there is a relationship between neurological sensory thresholds and observed behavior (1997). The Sensory Profile was used to provide an assessment of this relationship based on the report of patients who have CRPS. This type of test that measures behavioral responses was used in this study to inform a narrative inquiry to understand the impact that these disorders have on occupation.

Current scholars are integrating sensory integration theory into occupation-based intervention approaches by re-examining ways to broaden Ayres’ original concepts (Parham & Mailloux, 2001, p.…

"I'll see you always."

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(second in a recent series of self indulgent reflections on parenting)

Kids say things to parents and parents never forget those words. This goes for the things that you said to your parents and the things that your children say to you. That is why there is an unspoken understanding between children and parents that persists. Parents love their children and children love their parents. Even when other things sometimes get in the way.

There is little that is worse in my life than moments of separation from my children. The bittersweet part of this is that the children know this too. I guess I am not so good at hiding it.
I am away from my children this weekend, and it makes me think back to another time when we were separated because of my work.
I had just finished packing the kids into the van for their trip. They had it all planned when I tucked them into bed the previous night: they did not want to wake up, and they wanted me to carry them into the van and snuggle them in with their f…

On the intersection of being a parent and being an occupational therapist

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I spend so much of my professional time discussing parenting with parents - it only seems fair that I share some of my own parenting experiences.

I always feel that it is important that I tell parents that I understand their limitations because I have the same limitations that they do. I don't often get to give examples though so it seems that this is a good opportunity.
I have been thinking about the time that my daughter fractured her wrist - and I was too busy to notice. Sometimes I am not sure if time goes on around me, and events occur... or if I am actually a part of the stream itself, and time is happening with me. What I mean by this is that there always seem to be so many things going on and I grasp at those things that seem important - but it does not resolve the issues of those things that go past me. Only some don't go past - they stick to me, waiting for me to either liberate them back into the stream or do whatever else needs to be done.

Either way, sometimes when y…

Guest entry and debate on what constitutes occupational therapy practice

I received an email from Michele Karnes who wrote the following in the interest of advancing the debate on recent postings and comments regarding interventions that I consider quackery. Michele writes:

This offers a different view in response to your continuing competency column, OT's should be made aware of treatments that are offered to clients/patients, whether it is traditional or non-traditional, a long existing treatment or new one. This enables our OT profession and professionals to better educate the people they treat and interact with.

Instead of taking anyone's word that a particular treatment is 'mysticism' (as you put it) or the best thing since sliced bread, the OT who attends a 2-3 hour session can be introduced to the history and theory, what the treatment or program consists of, indications/contraindications, etc.

In response to Quantum Touch, it is based on the chi concept much like Tai Chi but focuses on therapeutic touch, a long standing principle used …

Erie County Executive Collins: Right and wrong at the same time

The issues are just too fast and furious lately - but this one had me falling out of my chair. Check out Collins comments on the burden of unfunded mandates from the State in this Buffalo News article.

Collins statement as it relates to preschool services is excruciatingly correct - although I am not sure if his solution really solves the problem. The article states:

"Besides Medicaid — the local costs for which eat up all the $200 million in revenues raised by property taxes in Erie County— Collins cited as among the unfair mandates a program that provides special services for children younger than 5 who need help to get ready for going to school.

He said the county pays the costs of the program — $23 million a year — but has no authority in running a program administered by local school districts. When children turn 5 and schools have to then pick up the costs, Collins said, pupils are “miraculously cured” and no longer offered the services."

This is oh so true, but the presch…

NYSOTA response re: continuing competency regulations

I received an excellent response from Jeff Tomlinson about the recent continuing competency issues. I didn't want his response to get lost in comments, so I am posting it as an entry. There is a lot of good information here. I would really like to hear more about the direct access issue and problems in securing scripts for school aged children - sounds like something that could benefit from roundtable conversation.

Anyway, here is Jeff's response:

I have also been encouraged by another occupational therapist to check out this discussion.
We were certainly surprised by the speed with which the physical therapists were able to pass their mandatory continuing education bill. It was quite an accomplishment in a legislative session that passed very few bills that regulated the professions. I will be talking to the lobbyist and the leadership at NYPTA about how they got this done.

At the same time, it should also be noted that the PTs continuing education law is not like the NYSOTA&#…

Time for more name changing?

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Juliet:
"What's in a name? That which we call a rose
By any other name would smell as sweet."



There is a history of name changes in describing sensory integration problems. People have probably heard:
SI disorderSID (sensory integration dysfunction)DSI (Disorder of sensory integration)SPD (Sensory processing disorder)You can check here for someone's blog entry on the issue. The SPD Foundation (formerly KID Foundation) has mostly scrubbed references on its website to the words that are no longer in vogue. That is helpful, particularly since they are seeking DSM-V recognition of SID/DSI/SPD.

Have I used enough initialisms and acronyms in this entry yet?

Now we have a companion problem in that there are multiple meanings for the concept of a 'sensory profile.' I was googling some information on the Sensory Profile assessment and I came across these references:

Sensory profile of mandarin chilled juices and consumers' acceptability

Mexican Mennonite-style cheese:…