tag:blogger.com,1999:blog-14772999.post5922446574805417320..comments2024-03-15T04:58:53.198-04:00Comments on ABC Therapeutics Occupational Therapy Weblog: 2011 Pushback against Fad OT InterventionsChristopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-14772999.post-33553769180197059172016-03-31T15:02:20.133-04:002016-03-31T15:02:20.133-04:00Kathy - you illustrate the ongoing problem with fa...Kathy - you illustrate the ongoing problem with fad therapies: "the evidence is right there in the manual". Forgive me if I'm not swayed by "evidence" created by the same individuals creating (and profiting from) these methods. It's this blind faith in sensory gurus that led the American Academy of Pediatrics to fire a legitimate and well-deserved shot across the bow of OTs and other practitioners of sensory therapies. Until we are explicit that these strategies "may work for some" but that "we're really not certain of why it works" because "the research is extremely limited or outright faulty", we're damaging our reputation and legitimacy as providers of effective interventions. We instead relegate ourselves to snake oil sales. The research in the manual is as bad as the research passed on via DPPT - poor design, biased, flawed. I'm not rejecting this outright (too many anecdotal stories of success), but this "because I said so" reseacrh makes me very wary.Stevenoreply@blogger.comtag:blogger.com,1999:blog-14772999.post-34176047294126156522014-08-14T06:06:29.639-04:002014-08-14T06:06:29.639-04:00Just came across this. As a parent of a young chil...Just came across this. As a parent of a young child with ASD, his very well-meaning OT insisted he needed intense spinning and the astronaut protocol despite the fact that it caused intense visual stims, causing him to be unable to take part in many activities, fall over things at the playground, etc. My son had those stims for a year. Each time the spinning activities were done the stim got worse so I asked her to stop. Then the stim would subside. She pushed doing them again several months later, I let her, the stim came back. <br /><br />I was told that the problem was I didn't spin him enough, that these things get worse before they get better, etc. I let the spinning experiment go for 6-8 weeks each time and for my child I found it seriously deregulating and detrimental.<br /><br />Also it strikes me that good OTs should be able to assess and individualize approaches and realize not all interventions will work for all folks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-14772999.post-81489782626885977342013-11-19T11:56:30.489-05:002013-11-19T11:56:30.489-05:0011/19/13
I received this in email and wanted to p...11/19/13<br /><br />I received this in email and wanted to post it here:<br /><br />Christopher,<br /><br />I just read your blog (posted in 2011) about Astronaut Training, and the lack of evidence supporting it. I appreciate your thoughts and ability to think critically about what we as Occupational Therapists are doing. I am in an awkward situation in which a private OT is recommending things that I as the school OT don't necessarily agree with. Do you know if there is any new evidence supporting Astronaut training in specific and spinning followed by heavy work in general? Many Thanks<br /><br />+++++<br />Here is my response:<br />Thanks for your note.<br /><br />There is no new research re: 'astronaut training' that I am aware of. <br /><br />The general question about the impact of rotational stimulation and 'heavy work' is a little more difficult. Both of these techniques are grounded in concepts originally described by Sherrington and then clinically expanded upon by Rood - in general we know that rotational stimulation can produced varied effects from increased alerting to autonomic dysregulation (pallor and vomiting). Heavy work/proprioception is known to 'close the gate' (as originally described by Melczak and Wall) on sensory stimulation. The more important question is whether or not eliciting these responses clinically will do anything meaningful from a 'treatment' perspective for children who have sensory/neurologic dysregulation. The bottom line at this time is that although individuals may have responses we can't predict what those responses will be for anyone in particular - and so a 'protocol' is not something that is really appropriate.<br /><br />Additionally, we have to look at what is the best way for us to be spending our (generally restricted) treatment time. You can certainly 'try' some type of stimulation regimen (commonly called a 'sensory diet') and see what kind of anecdotal responses you get. So, if a child has arousal and alerting difficulties, the concept of physical activity to support attention is not out bounds at all. The problem is when we start getting prescriptive on these 'sensory diets.' Perhaps it is better to just promote recess and phys ed participation (reference the AAP policy statement on recess at http://pediatrics.aappublications.org/content/131/1/183.full). You could also try 'movement breaks' if the classroom context is overly focused on desktop learning. It is not correct to be overly prescriptive because there is no evidence that suggests these prescriptive therapy approaches are effective.<br /><br />We know that promoting recess is important. We also know that children who have attending and regulatory difficulties can have modest benefits from parent and teacher training, cognitive behavioral interventions, and functional skills training to support their academic participation. For now I would stay away from prescriptive 'astronaut training' programs.<br /><br />Thanks for writing,<br /><br />ChrisChristopher J. Alteriohttps://www.blogger.com/profile/09489464791931315291noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-21889662513446328922013-10-30T19:25:13.076-04:002013-10-30T19:25:13.076-04:00Thanks for your comment Kathy - I included it in ...Thanks for your comment Kathy - I included it in my post that highlights my favorite comments or reviews that I have received. I really wish you would have the courage to leave your full name though.<br /><br />I would like to retire, but when I get comments like yours and it makes me think that there are still people who actually might benefit from my opinions.<br /><br />Just so you know - I am interested in new concepts as they come to our field. You may have missed one that made its debut around 2000 - called evidence based practice. I admit that it is not so shiny and new right now but you might look into it sometime - it is quite interesting!Christopher J. Alteriohttps://www.blogger.com/profile/09489464791931315291noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-68479098176667086112013-10-30T18:11:26.506-04:002013-10-30T18:11:26.506-04:00Wow-you really need to do your research a little b...Wow-you really need to do your research a little bit better. There is research documentation regarding sensory brushing protocol and Therapeutic Listening. The research you are looking for regarding Astronaut Training is in the manual, not on some weblink on the internet. The I have been an OT for 24 years, all specializing in pediatrics. It is sad that someone in our field is so negative about new techniques to use in our practice. I hope you are nearing retirement. We need people with more open minds in our field.Kathyhttps://www.blogger.com/profile/02318100919117952659noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-67959462064979644742012-01-12T23:13:08.087-05:002012-01-12T23:13:08.087-05:00This is a good end of year review - well, except k...This is a good end of year review - well, except kind of a downer. <br /><br />Speaking of deja vu presenters without evidence back-up - I found a couple of circa '80s OT speakers still making the rounds about 3 years ago. <br />http://www.therextras.com/therextras/2008/09/introducing-senory-gurus.htmlBarbara @ TherExtrashttp://www.therextras.comnoreply@blogger.comtag:blogger.com,1999:blog-14772999.post-47284207479044632252012-01-01T21:11:50.589-05:002012-01-01T21:11:50.589-05:00This comment has been removed by the author.Karenhttps://www.blogger.com/profile/16213944904796774622noreply@blogger.com