ABC Therapeutics Occupational Therapy Weblog

I received an email today regarding a parent who was interested in finding training on how to implement a 'brushing' program on their five year old child. The child's therapist allegedly encouraged the parents to research it themselves - which seemed a little odd to me. This got me thinking: perhaps there is a population of therapists who just can't find resources on the Wilbarger Approach. I can understand the frustration. There has been very little published in the literature about this approach - perhaps the two most-cited references of the authors themselves are Wilbarger and Wilbarger (1991) and Wilbarger and Wilbarger (2002). These are not research studies; they are just descriptions and theoretical ideas about the concept of sensory defensiveness. There are studies that have been published by others but they have been single subject designs or they have been published in newsletters. The Sensory Defensiveness website (allegedly sponsored by Patricia Wilbarger) ha...

April is OT month. It seems that every group, movement, or cause has a Day or Month. Still, April has always been OT Month in my mind, long before I found out that it was also Autism Awareness Month, Cesarean Awareness Month, Child Abuse Prevention Month, National Humor Month, National Welding Month, National Garden Month, etc... you get the point. In the past I have done public service announcements on radio , radio interviews , spent money on advertising , endured a promotional cable-access 4 part series, (think Wayne's World meets OT ), and of course there are the standard guest lectures in front of highschoolers that could care less , giveaways at college job fairs, and the perennial poster presentation in the employee workroom/cafeteria/front hallway. This year I decided to do something of more substance. This website remains an ongoing project to support the cause, as is this other website . (Shameless method for generating more web traffic). Then there was my real televisi...

This entry is relatively esoteric, but I spent time researching Horner Syndrome so if the information can help even one more person I suppose that posting it here is worthwhile. This is truly the benefit of the Internet: things that waste space on my hard drive may be a treasure trove of information to someone in the world. Here's hoping. *** Introduction Horner syndrome, also identified as Horner-Bernard syndrome or oculosympathetic paresis, is a constellation of symptoms including miosis, ptosis, apparent enophthalmos, anhidrosis, and reddening of the conjunctiva (Adams &Victor, 1985, p. 208). This condition was described through observations of animals by the French physiologist Claude Bernard. Additionally, some of his co-workers were American surgeons who described this condition in a Civil War soldier who had a cervical sympathetic nerve injury (Kisch, 1951). However, Johann Friedrich Horner, a Swiss ophthalmologist, is generally credited with the first full description o...

At some risk, I occasionally offer self-reflective entries that explore narrative meaning to childhood occupations. Background for this current self-indulgent essay can be found by reading about the occupation of collecting . In this previous essay I wanted to explore rule making and gamesmanship – now I seek to expand discussion of this occupation into a theme of how environment and context shape the occupational experience. Unstructured neighborhood play is not common today, and it is a significant loss for children. Imagine if I never experienced this: *** During a recent trip home I visited my parents and noticed all of the things that were changing. I know that they have been changing steadily, but for some reason I recently noticed this more acutely. The waterfront looked especially good, and as I scanned the rows of new buildings I saw one older but beautifully restored building with a landscaped waterfall alongside it. And I remembered the time that Brian and I found a dead bo...

Introduction I am frequently asked - "Does this child have an attention deficit disorder, or is it a sensory integration disorder?" I generally respond that I don't know what either ADHD or sensory integration disorders are. There is a fundamental problem that we have in diagnostic evaluation: professions have created 'disorders' before there is an understanding of the mechanisms underlying the disorders. This opens up the possibility for criticism because we begin calling 'disorders' by names and then have no basis for backing up our opinions. I still feel relatively comfortable stating that I don't know what ADHD or sensory integration dysfunctions are. This confuses people who are looking for answers but I believe it to be the most honest response that is possible for this question. I believe that there are multifactorial reasons why children behave the way they do. Some of those reasons are neurologically based and some are behaviorally based. I w...

I received a phone call today from a mother who wanted to ask me a question. “Why is Patrick talking about eating cake or vegetables every time we work on his homework?” Having been exposed, I had to tell the parent this story: During a recent therapy session I sat next to 6 year old Patrick while he completed a puzzle. I was watching his strategy for putting the pieces together. As he skillfully interlocked the pieces he announced, “Mr. Chris, this is a piece of cake.” Seeing that I needed to add some complexity to the activity I replied, “What are you talking about? That’s not a piece of cake. It’s a puzzle.” Children who have Asperger’s Syndrome sometimes interpret language literally, and as Patrick had a severe difficulty with this I thought I would challenge him a little. “Why are you saying that the puzzle is a piece of cake? It’s not even a piece of cake – it’s a puzzle of a dinosaur. You don’t make any sense.” Patrick paused, trying to understand my response. “No, Mr. Chris. I...

It is critical for occupational therapists to understand the nature of power relationships and control mechanisms when they are working with children or adults who have disabilities. I understand that I can take steps beyond what I will express here – and begin a discourse on the very nature of identifying the concept of disability – but I want to ignore those larger issues and instead focus on the relationships between those who are already identified as ‘disabled’ and those identified as ‘normal.’ So for the purposes of this discussion, we will overlook the discussion that ‘medicalization’ creates power differentials and supports social control in itself. I am not an ivory tower academic. I am just a street-level occupational therapist who is trying to do a good job and to appropriately serve the people who ask me for help. I mention this because if anyone reads this I want them to know that my interest is grounded in the tasks I am asked to do everyday. This is very real to me – it...

Occupational Therapy: The Profession that Focuses on Life Skills For millions of people, the service of occupational therapy is a lifeline. People of all ages receive it to help them participate in the activities of their daily life. Sometimes people need occupational therapy to do things we take for granted, like getting dressed, being productive at school or work, eating unassisted, even socializing. Occupational therapy doesn't just treat medical conditions, it helps people stay engaged in the activities that give them pleasure or a sense of purpose, despite challenges. Occupational therapists do this by helping people surmount their disabilities or medical conditions to do everyday things. The nature of the therapy depends on the individual and their environment; occupational therapists consider the whole person when developing a therapy plan. Occupational therapists collaborate with physicians and other professionals to ensure a comprehensive approach. Children, for instance, ...

For background information, you may first choose to reference this entry: An analysis of foster care policy and its impact on occupational therapy INTRODUCTION Children are placed in temporary foster homes when their parents are unable to care for them; foster care is generally designed as a temporary service for children and families who are experiencing a crisis. Children in foster care are more likely to experience psychological and developmental problems (Simms, Dubowitz, & Szilagyi, 2000); therefore, there is an increased likelihood that they attend early intervention and preschool programs where occupational therapists provide services. Occupational therapy education programs have been successful in increasing therapists’ knowledge and skills in working with parents of children who have disabilities (Hinojosa, Sproat, Mankhetwit, & Anderson, 2002). However, little has been written about occupational therapist’s interactions within the foster care system, particularly as ...

Hi everyone... Just a quick note to let you know that after playing around a lot between ATOM and RSS I decided to keep the ATOM format for feeds. So if you saw a funny version of the blog in the last 24 hours with RSS feeds enabled, I was just kidding. Occupational therapists are not supposed to know about programming these changes, and that is my excuse. Either that or Blogger doesn't like RSS. I am wondering now how much damage and confusion to my site feeds I have caused with these changes. Oh well.

Tony was a middle-aged man of Italian-American descent. I watched him limp toward me slowly as he leaned a little too heavily on his cane for support. He had a difficult time walking: his left leg was held relatively stiff and he struggled to avoid dragging his toes as he worked diligently to advance his hemiplegic extremity. His left arm was not faring much better. It hung limply at his side, obscenely lifeless. "My arm feels like a puppet on a string," he would say to me, "but there is no Gepetto to make this tired old body move." Tony wasn't really that old. He had just retired from the railroad where he had worked for the last 35 years as a conductor. His only child was grown - a successful radiologist in the rural community where we lived. Tony and his wife had no real plans for retirement. They didn't have much of an opportunity to formulate plans before he had the stroke. The stroke primarily affected Tony's left arm and leg. He was able to commun...

Let me first say that I have no doubt in my mind whatsoever that Snoezelen-type environments are soothing, relaxing, and stress-reducing. I don't need to read any scientific articles to tell me this - although I did do an OVID search tonight and was not surprised to see many studies (of varying degrees of quality) say that Snoezelen was effective toward these ends. But I don't even doubt the poorly designed studies - I accept their reports of support for the calming effects of Snoezelen environments. Snoezelen and other sensory based interventions for adults who have psychiatric disorders were discussed in this week's OT Practice (Costa, Morra, Solomon, Sabino, & Call, 2006). The article describes Snoezelen as 'failure-free' and 'passive' but apparently some of the interventions involved actively teaching the clients relaxation exercises and deep breathing techniques. The authors report that the clients had some increased relaxation, even to the point of...

There is a longstanding lack of access to educational programs for students from the Gaza strip. This issue is very controversial as it is steeped in the regional geopolitical quagmire of the Israeli-Palestinian conflict. Some of the reasons for Israeli control of movement between the occupied territories seem legitimate - from their perspective, people under the age of 35 represent the greatest threat with regard to terrorism. Are the ten occupational therapy students currently in the news likely to have explosive belts under their clothing? I don't know - but this is a topic worthy of discussion - it is a real-life manifestation of the concept of 'occupational justice.' Occupational justice may not be a term that is well known to all occupational therapists, particularly those in the United States. Wilcock first identified the term, stating that it was an extension of social justice and specifically relating to opportunities or lack of opportunities for normal human occup...

This is a follow-up of another story that you can find here: Billy's World I was surprised as I read the fax that was printing out the new referral. The school system wanted Billy re-evaluated - which I thought was odd because last I knew he was already enrolled in a preschool program. The information on the referral indicated that he was now in the custody of his aunt and that she was trying to get him re-enrolled in the preschool program. I called the referral source and stated that I knew Billy and that I looked forward to seeing him again. My immediate thought as I entered his aunt's home was that it was much cleaner than where he previously lived. The strong odor of cigarette smoke hung in the air and in every corner, so despite the fact that the home was superficially clean I still knew that I would have to de-fumigate myself after the visit. This made me feel badly for Billy, because he has to live in it every day. Still, this in itself is nothing that is reportable - ma...

The Occupational Therapy Practice Framework (AOTA, 2002) identifies personal contextual factors that support occupational performance. The Framework identifies these factors as “features of the individual that are not part of a health condition or health status.” This definition is directly quoted from the International Classification of Functioning (WHO, p. 17). Unfortunately, although contextual factors are identified in the Framework, the relationship to occupational performance is not clearly stated. So although personal contextual factors are not clearly defined, this Framework represents another step that explicitly identifies contextual factors as being critical to occupational performance. Several different sources in the post-modern period had a strong influence on the inclusion of personal contextual factors in practice models. New practice models that specifically emphasize these factors are still being developed and refined. Many concepts from the new discipline of occupat...