ABC Therapeutics Occupational Therapy Weblog

Jennifer stomped into my office, hair askew and wet socks flapping around her toes. "I hate my shoes and I don't care about the seven day rule!" Jennifer is 9 years old and has severe regulatory difficulties - a psychologist has provided the label of ADHD. She has accompanying motor incoordination, complicated by her generic lack of persistent attention to much of anything other than the Winx Club . As a result she has a hard time learning in school and socializing appropriately with her peers. She has been coming to see me privately for a few months now because she has been discharged from the school program - I am still not sure I understand why. That's another post, I suppose. She has made some good progress with improving her posture, learning to control her body to maintain a sitting position for a longer period of time, and in maintaining persistent attention during non-preferred activities. She has made less progress with her actual handwriting and emotional st...

One of the best questions that people ask me is if I 'believe' in sensory integration. I haven't really answered that directly, so I will try. I am motivated to do so because I just got the question again today - and I don't want to post the comments that were left because there was too much identifying information - and the person did not leave an email. So I hope the commenter sees the response here. I suppose that people see my commentary and questioning about sensory processing and the need for evidence as being 'critical' or 'unbelieving' in the diagnosis. I commented recently about the concept of 'fidelity' when talking about sensory integration because one of the problems is that it is being so poorly defined by so many groups, including researchers. Even our 'state of the art' assessments are horribly intertwined between asking behavioral questions and sensory questions. I believe that it is getting increasingly difficult to...

I decided recently that I have an issue to face: what to do with my post-doctoral time? Participating in the doctoral program at Nova Southeastern University effectively consumed every moment of my waking (and in strange ways sleeping) consciousness. This process carried me through approximately 5 years. Somewhere and somehow in the course of that time period I transitioned back to full time clinical practice, grew our private practice to 15 employees, started this blog, and watched my two older children grow through their high school years. I have a doctoral degree now. So now what? My initial response to this extra time was to immerse myself in what was supposed to be mindless leisure pursuit of video games. It was an odd transition off of a distance learning program. I was accustomed to living my life in asynchronous debates via WebCT, researching and reading in the vast online resources of NSU, and writing writing writing writing papers. I was used to being ON THE COMPUTER, s...

...You can't take my identity away from me. You can take my sign though, apparently. My apologies for vague geek references with the quote. Anyway, what is a sign? I guess it is useful for letting people know where you are, or what you are about. It is an outward representation of you - but it is not you. It does not have the substance of you, although it may have some superficial representation of what you are about. We all have signs. Some of them are the clothes we wear or the personality we express on any given day. I am sign-less this evening. I awoke this morning and was receiving many signs, of a different sort. I felt watched over today, which I understand is entirely unbelievable after this other information I am about to share. But I drove up to a school to do a few evaluations this morning and I felt watched over . It isn't a feeling I have on most days, to be sure, and I thought it was odd. Work-life has been roiling lately - switch to a new payroll system, end o...

I have often stated that the inter-activity generated as a result of this blog is endlessly entertaining to me. I just received this wonderful note about my statement on the blog that reads "This product is sold by weight, and not by volume" : Hi Chris Is that a little witticism referring to Gregory Bateson and his little metalogue on knowledge “How much do you know”? I’m soon to graduate with a BA in Anthropology. I’m thinking of pursuing a MS in OT I have a very holisitic view of communication and life; they are one and the same in my book. Do you have any advice or recommendations? I’m very interested in communication theory from bio-semiotic-cybernetic perspective. Hope to hear from you soon. +++++++++++++++++++++++++++++++++++++++++ And my response... (slightly edited) Thank you for your note – although I chuckled at your question and then started thinking about the act of deconstructing my own writing, and then got all tripped up on subject-object perception about what...

I received this email today, and I thought it was a great question: I am an adult who has Sensory Integration problems that were diagnosed three years ago. I also have central auditory processing disorder and was recently diagnosed with Asperger's. I have had some OT in the past for the SI difficulties, and was wondering if you knew of services for adults with these problems. ++++++++++++++++++++++++++++++++++++++++++ Sensory integration refers to an 'unseen' process that has not yet been clinically defined - people have suggested that it may be a neurochemical problem, or perhaps a neuromigrational problem, or perhaps something else entirely. However, occupational therapists are claiming that it is SOMETHING that has to do with neurological processing - a lot of current research is looking at sympathetic and parasympathetic sensory processing of information. There are also some occupational therapists who claim that the prevalence of SPD can be as high as 5% (in the 'n...

When we see people who need occupational therapy they have to be understood in more than organic terms. That may seem obvious to some but I know it is not obvious to all. I know that it is not obvious to all because so much of clinical practice looks like it is oriented toward the organic or biological level. People are more than the sum of their parts, of course - and that is why I find it so important to let my anthropologist out for a walk. I was reviewing these 'field notes' from some time I spent teaching at a college - and I wondered how different the intervention plans would be if they both came to an occupational therapy clinic with similar injuries or needs: Penny and Natalie are moving in two different directions. I watched their trajectories intersect for a couple months and it provided a lot material to think about. Let me start by saying that they don't even know each other. But they are the same age - having both just turned 21. Natalie will graduate in a yea...

I got email from a parent today asking me how to answer some difficult questions from her son. I told her that it was ok for parents to 'make up a story' for the short term if the real issue at question was too developmentally complex for the child to comprehend. Parents have a lifetime to be honest with their children, and sometimes it is ok to hold the truth for just a little while. The truth is hard for children to understand, sometimes. I admit that I have a long history of 'telling stories' to children. I do this for fun, and to sometimes promote a fantastic world to them. The world is so much more fun when it is also fantastic. So although I 'stretch' the truth I also know that you reap what you sow (in so many ways). I know this intuitively. This is something that I always keep in mind, hopefully in the forefront, as I go about the daily tasks associated with raising and also in working with young children. But inevitably, kids ask difficult questions and...

As promised, here are a few pictures of our new space... this is the desk I am currently sitting at and making this entry. It belongs to the receptionist but I have temporarily taken over until I get my own office out of boxes. This is one of the gross motor areas. Phase II of our building project will add an additional gross motor gym, as well as an outdoor play area and bike path. With over an acre to develop we are having a lot of fun developing ideas! We especially love the interior design that makes it feel so open and fun for swings! Here is Danielle Green, a Level II student from Quinnipiac College, working with one of our friends in the fine motor treatment area! ...and of course we always have time for fun at ABC Therapeutics! Here is a nice picture of our two Halloween ladybugs!

People are easily confused whenever someone talks about sensory integration or sensory processing, mostly because of confusing messages that are sent by occupational therapists regarding these issues. Confusion is evident in the public but it is also interesting evident among occupational therapists and researchers as well. There have been some recent efforts to address this confusion by initiating conversation about ' fidelity ' in sensory integration research. This means that when someone claims that a study is about sensory integration that it REALLY is about sensory integration. I encourage people to look at the Sensory Integration Global Network website; it has a lot of good information that helps to clearly define the concept of sensory integration. However, it is also important to understand that sensory integration research is not equivalent to occupational therapy research. Evidence supporting or refuting a sensory integration approach is NOT the same as evidence...

I frequently get email from people asking me about Brain Gym, so I thought I would post one of the emails here. Identifying details have been changed but the letter is essentially intact as written: Dear Chris, My son is 11 years old and in the 6th grade. He has Neurofibromatosis Type 1 which is a neurological disorder that affects his entire nervous system. He has Apraxia of Speech, ADHD, auditory processing issues and learning disabilities. We took him for a speech eval and they suggested sensory integration therapy. This summer, based on recommendations from our speech therapist who is GREAT and one of the few people who have actually been trained to treat Apraxia, we began OT with couple of therapists who do sensory integration therapy and are very much into Brain Gym. I’m really starting to question whether Brain Gym is effective for us. We’ve only gone a couple of months, but I really don’t see any improvements. My child is social, independent and making progress…he is in a mains...

Autumn is a point of change. A transition from green to gold. Certain things happen in Autumn; they are the same each year. Thoreau said that 'Time is but the stream I go a-fishing in.' I think that as occupational therapists we need to remember to consider how important time is, and how it is the grounded substance that we all function within. Things look different when you see the time that they are occuring within. Today, as I was driving through the winding backroads of the rural countryside on my way to home visits, the world was rotating through time. Of course it rotates every day, but today the rotation was palpable. I noticed a school bus in back of me and two young children holding purple flowers on the side of the road, peeking around the hedges to see if the bus was coming. It was something that had happened a thousand times before - not just by these children today but by their parents before them. And their children will do the same. They will be running out of fr...

ABC Therapeutics staff took a break from beginning of the year activities of scheduling, working with children, and even unpacking boxes in the new office to visit with Diana Henry. Diana is in town to present her "Sensory Tools for Pre-Teens & Teens workshop" at the NYSOTA conference. She will also be presenting on the Sensory Processing Measure. We had a wonderful visit with Diana and her husband Rick. We were all excited to hear their stories and she gave us some wonderful ideas about organizing our new clinic space! From left to right in this photo: Marjorie Deschner, MS, OTR; Grace Kelley, MS, OTR; Diana Henry, MS, OTR; Lucy Pencille, MS, OTR; and Caroline Alterio, COTA, ROH. Somewhat hidden is Jean Luc Pencille, but I wouldn't want to neglect mentioning him!

I have neglected this poor blog lately, despite my intentions to write more. I apologize to all my fine readers who have sent me emails asking if my computer has died... ;) My current activity configuration involves project management on a 'Flip this House' magnitude. We purchased a new building that required some substantial renovations, but now we are ready to move at the end of this month. Soon I hope to have some pictures to post of our new 'home.' Stay tuned - I am hip deep in boxes and packing material, paint and drywall, building inspectors and certificates of occupancy. Change is on the horizon!

Teaching someone a skill is not necessarily a difficult thing. Skills are concrete, task-like, discrete, and relatively well defined. I have always tried to avoid teaching my students skills because it is my opinion that they need so much more than skill (although sadly they clamor for skills more than they clamor for background knowledge and understanding). Instead, I try to help my students develop some degree of critical reasoning, problem solving ability, analytical capability, and appreciation. I believe that these attributes will carry them farther than will the mere acquisition of skills. This is a stretch for many of my students - these demands take them places where they have not really been challenged before. As a result I notice that their confidence is dramatically decreased when they are taken beyond the stages of rote memorization. Because certitude is important I do not accept questions when I have asked them for answers. "Are you asking me or are you telling me?...

I received my "certification" to administer and interpret the Sensory Integration and Praxis Tests in 1992. I believe that the test battery was published in 1989 so it was still fairly new at the time I was certified. At that time there was a certification examination that you had to pass. I don't know how psychometrically sound the SII program was - but they claimed that it was a certification program. SII never wanted me to 'recertify' though - which is a little scary. In the past twenty years the Sensory Integration and Praxis Tests have not been updated and there are no new norms. I have never heard of an occupational therapist talking about the Flynn Effect or heterosis so I don't know if anyone believed that there is a useful lifespan of an assessment tool. Some OTs still use the old Bruininks-Oseretsky test that has 25 year old norms - they just got around to updating those norms recently but I still see a lot of reports with the old test given. Persona...

I was surprised to see an article in the NY Times (Science Times) on sensory integration on 6/5/2007. I grew up being addicted to the Science Times section of that paper so I have some long term positive bias for anything that appears in that section of the paper - even though I don't particularly like the NY Times in general any longer. So I have some bias, because I am like Virginia O'Hanlon reading something that Frank Church wrote just for me... but the article on sensory integration was relatively even handed so I was pleased. I am a critic of the current state of research for sensory integration so I was happy to see the anecdotal reports of parents and the interesting research that people like Patti Davies are doing on neurophysiological underpinnings of sensory processing all in the same article. The research funding problem is also described well. This is an article that will be good for the general public and for other researchers and professionals to read and consi...

My apologies for the prolonged absence - and thank you for all the emails wondering if I was still alive! I began my private practice 7 years ago with the mission/intent to put myself out of business. At that time I was getting phone calls and requests from families to assist them with their IEP process. It seemed that a lot of the difficulties were in communication between educational teams and families - something that could be easily remedied. Since there is a prescribed 'rulebook' on how the process needs to be conducted I believed that helping families learn the rules would enable them to become better team players who could advocate for their children appropriately. Fast forward 7 years and now I am helping both families and school districts with the rulebook - but the solutions remain elusive. More families who are dissatisfied with their IEP process find me each year. Sometimes the families need to adjust their approach. Sometimes the districts need to adjust their ap...

As promised, I wanted to review some of the articles in the current (March/April 2007) issue of the American Journal of Occupational Therapy. Since I have gotten some emails and blog comments asking me about the Hall & Case-Smith study (see reference below) I thought that this would be a good article to begin discussing. I was excited to see a study on this intervention technique because I have been hesitant in the past to fully embrace 'therapeutic listening.' In my opinion there is not adequate evidence to support promoting this technique so I was interested to see if this new study would change my mind. I believe that the authors should be commended for initiating this inquiry, but I also believe that their conclusions are far overstated. There are several fundamental flaws in their design that are concerning. To begin with, they used a convenience sample. This might have been appropriate if the study was truly exploratory, but there have been several other studies alrea...

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 ...