ABC Therapeutics Occupational Therapy Weblog

Something unfortunate has been happening in occupational therapy, and I’ve been watching it develop for years. At first it was a little distant but now it is uncomfortably close. The profession has always had its share of plucky innovators and small-scale entrepreneurs, but the landscape has shifted. An increasing number of young therapists are building a “personal brand,” launching a subscription service, or producing downloadable content with a logo and a tagline. These are not just side hustles - for some, it is the work. None of this is inherently bad - and I understand why it happens. Salary-to-debt ratios look like a punchline and clinical autonomy is chipped away by policy and productivity expectations. It makes perfect sense that people look elsewhere to find meaning, income, or both at the same time. But something gets distorted when the gravitational pull of monetization starts to reshape what counts as knowledge in the field. The distortion becomes even more concerning wh...

I came into occupational therapy as a street level clinician. Like many of my generation, I learned Ayres Sensory Integration (ASI) in school. I took additional steps to get certified to administer and interpret the Sensory Integration and Praxis Tests (SIPT) when they were first published, and tried to make sense of what the model promised. Over the years, I watched that test become outdated, all while  waiting for the robust evidence base to emerge. I was told at countless workshops and conferences, " The research is coming. " It never did. In the meantime, neuroscience did not stand still. We now have dynamic systems theory, heterarchical processing models, robotics, and AI-driven neural networks that give us far richer and more precise understandings of how brains actually develop and adapt. These frameworks have left Ayres’ mid-20th century metaphors behind. I say this not as an outsider taking potshots. I am a clinician who has lived with the sensory integration mode...

Lately, the conversation around gender in athletics, education, and therapy has gotten a lot more complicated. Questions about fairness, biology, and statistical interpretation are at the heart of some heated debates—whether it's about competitive advantage in sports or access to essential services like therapy. While these issues might seem separate, they both hinge on a common problem: how statistics are used (or misused) to justify decisions. I recently came across a post from an athlete who was assigned male at birth but is now competing in women’s sports. This issue connects directly to occupational therapy because it highlights how statistical reasoning—whether in competition or clinical settings—can shape real-world opportunities. The athlete argued that their transition had led to an ‘equitable’ change in performance by comparing their high school results in men’s competitions to their current college results in women’s competitions. The key claim? Their relative standing w...

***As a commenter below noted, as of 9/22/17 the link to the AOTA infographic with dubious information is broken/has been removed and now serves a 404 error.  Hopefully this is an indication that there will be more care in the future about quoting statistics. The removal of the infographic does not address the question about whether or not there may be more impactful injury prevention efforts than concern with wearing heavy backpacks.  (edited, 9/22/17, CJA). According to the American Occupational Therapy Association, heavy backpacks can cause serious injury to children.  The AOTA claims that heavy loads carried by 79 million students across the United States "can cause low back pain that often lasts through adulthood."  The AOTA also claims that according to 2013 statistics from the US Consumer Product Safety Commission nearly 22,200 strains, sprains, dislocations, and fractures from backpacks were treated in hospital emergency rooms, physicians' offices, and cli...

Please note first that there is no formally recognized clinical designation of  'sensory processing disorder.'   It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community. In our clinic we receive many referrals from local pediatricians when parents have concerns about children being overly sensitive to their clothing.  Most often the children referred are from four to seven years old and the families are severely disrupted by the children's behaviors and responses to clothing issues.  Commonly, children will have severely constricted tolerance for certain outfits, want to wear the same clothes repeatedly, complain that clothing is itchy/scratch/bumpy/wiggly/ouchie, and this all leads to disruption of daily dressing routines.  There is no doubt that the behavioral concerns are very real. The pediatricians tend to be appropriately conservative and provide families with good behavioral manage...

Today's Wall Street Journal includes the standard article in its Life/Health section on Sensory Processing Disorder that we are all accustomed to seeing published every six months or so. The general idea of these journalistic offerings includes the standard trope of expert occupational therapists who can identify a disorder that the medical community can't quite agree on.  It also includes the standard ethical bombshell that occupational therapists can't bill insurance for this therapy and that the costs are $175 per session and are needed for 18 or 30 sessions, depending on who you ask.  Maybe it depends on credit card limits in different geographic localities, I am not sure.  The fact that the cost for this therapy can range from $3000 to $5000 is in itself a red flag that should make most parents squeeze their wallets shut and run for the hills.  The fact is that there is no consensus on frequency of these interventions and there is also no consensus if this 'i...

Sometimes images can convey an action or feeling better than words, so I offer this as representation of the occupational therapy profession's response to the Washingtonian article that some in the profession believed was overly critical: Like the Spartans, many occupational therapists responded to the message in the article by killing the messenger.  That might not be the best idea. I made the following comments in the article but since I am not assured that those comments will persist I thought I would document them here. Some OTs are concerned that the article is unfair and undermines the legitimacy of OT in general and their work in particular.  First of all, a magazine article can't undermine the legitimacy of anything. It is a piece of journalism. As such it has some reporting elements and invariably there are some differing opinions injected. Those opinions exist outside of the magazine article. The article does not undermine legitimacy; the opinion...

Each year I receive several emails from colleagues about 'retained primitive reflexes.'  I am also seeing an increased number of reports from local 'health care' providers who are documenting these alleged problems so I thought I would write a summary of my opinion on this topic.   Predatory 'health care' providers including some OTs, PTs, chiropractors, and behavioral optometrists are creating a new 'market' for treating this alleged 'problem.'  Parents should be very wary of these practitioners and other professionals should challenge these practices whenever they are seen. The following is the kind of information that causes concern and was provided to me by a colleague as a sample from a student's IEP: The student continues to demonstrate the following retained primitive reflexes that at times interfere with his ability to demonstrate appropriate adaptive responses: Fear Paralysis Reflex, Moro Reflex, Palmer Reflex, Tonic Labyri...

I received several emails asking me about the dialogue that was recently published in the Journal of Autism and Developmental Disorders regarding the Schaaf, et. al (2013) study.  A kind colleague forwarded the comments to me and I had the chance to review them. Ashburner, Rodger, Ziviani, and Hinder (2014) made some comments about the original research.  They basically outlined concerns with the parent report measures, lack of blinding, and confounding impact of invested time for the parents.  They also expressed concerns with dosage and non-equivalent treatment conditions between groups.  The original authors (Schaaf et al, 2014) thanked them for their comments and expressed that a treatment manual would be published later this year that might help others replicate the interventions.  They also expressed that they are following a step-wise method of progression from case study to feasability study to RCT.  They state that future studies will address ...

I was very happy to see another article on weighted vests in the current issue of AJOT (Lin, Lee, Chang, and Hong, 2014).  The last opportunity we had to look at this issue was the excellent pilot study completed by Collins and Dworkin and published in the November/December 2011 AJOT.  In that study ( reviewed here ) the authors found that the weighted vests were not effective in increasing time on task, but cautioned that the results should be generalized cautiously owing to the small sample size and participant selection process. The current study, completed by colleagues in Taiwan, employed a much more rigorous randomized and two period crossover design with a much larger sample of children.  110 children participated in the study that measured their performance on the Conners' Continuous Performance Test and recorded behaviors during weighted and non-weighted vest wearing conditions. The researchers made good attempts to control for bias by blinding the video cod...

New day.  New information.  Same narrative. The January 20, 2014 OT Practice publication has a brief article under the 'Industry News' section on page 2.  The article is entitled Study Finds SI Improves Function in Children With Autism and it links to the recent Schaaf, et al (2013) article that I posted about two months ago. What has happened in the last two months?  Well, there was a lot of social media conversation about that article.  On December 4th Diana Henry posted a link to the article on the OT Connections site and entitled her message thread " OT/SI: Finally recognized for treating autism! "  Some very beginning conversation occurred, which was very encouraging, but there is not nearly enough interest in discussing the way that we herald these studies when they are released.  My post in this thread encapsulates some concerns about designs that are reliant only on parent report: When the results of complex studies get reduced to sound...

Occupational therapists have been attempting to improve research on sensory integration by adopting more strict fidelity standards and by using Goal Attainment Scaling as an outcome measure.  Three years ago I blogged about an SI effectiveness study and expressed some concerns on the research design - you can read about that at http://abctherapeutics.blogspot.com/2011/01/new-study-on-si-effectiveness-but.html. A new study has been published by Schaaf et al (2013) and can be accessed online in full text at http://link.springer.com/article/10.1007%2Fs10803-013-1983-8/fulltext.html  However, one major difference is that in the new study the researchers used an intervention and a 'usual care' group. Use of control groups in this manner can help to correct for potential Hawthorne effects - but only if the study is designed properly.  In the previous study there was an OT/SI group and a fine motor training group.  The fine motor group in the first study was probably no...

Almost seven years ago I wrote a blog entry on pediatric fecal incontinence which is archived here .  In that review I briefly discussed psychological and physiological and regulatory factors that might contribute to the problem.  The evidence at that time indicated that dietary, activity, and cognitive behavioral interventions were most likely to be successful in helping families. I also discussed a common occupational therapy mythology that sensory processing factors such as preference for deep pressure stimulation might contribute to fecal retention.  There has never been any evidence to indicate that this is a relevant factor. In the current issue of the American Journal of Occupational Therapy there is an article by Bellefeuille, Schaaf, and Polo (2013) that describes OT intervention for a child with retentive fecal incontinence.  The authors hypothesize that a 3 year old child's difficulty with passing stool is related to overresponsivity to sensory stimul...

I personally always fished with worms, or occasionally newts - but I am no fisherman and my knowledge of this occupation is restricted to the things a young boy would gain by spending summers casting into the Hudson River more for a way to commune with friends than for the sport.  Back then it never really mattered what we caught or even if we caught because the occupation was directed toward the social experience.  Besides, there is nothing worse than having to get a river eel off of your line.  Gross. Anyway, I was preparing a lecture and the concept of 'emerging practice area' ran across my radar screen.  This is certainly nothing new in OT.  The word 'emerging' seems to be an interesting buzzword in occupational therapy right now and it is applied across many contexts.  There are 'emerging leaders' and there are 'emerging practice areas' and there are 'emerging fieldwork sites' just to name a few.  It must be important because there are ev...