ABC Therapeutics Occupational Therapy Weblog

 A couple posts back I blogged about a new tool that has been in development called the Comprehensive Observations of Proprioception.  I was a little surprised about the editorial decision to publish an article about performance on the tool without publishing about the tool itself.  Now we have a paper on the tool itself - so the ordering of publication is a question for AJOT editors - not the authors of the paper. The authors describe the tool as an observational measure that is criterion referenced.  The test includes 18 items that purportedly represent some aspects of proprioceptive function and they use literature review as one tool to substantiate the content validity of the items.  As I mentioned in the original post on this matter I am concerned that some of these items might represent some aspect or measure of proprioception but then again they also might not.  Fully 25%+ of the items are behavioral measures like 'overactive' and 'enjoyment when ...

More regulatory mumbo-jumbo, while I am on a roll: The New York State Department of Health has proposed an amendment to Subpart 69-4 of Title 10 of the New York Codes, Rules and Regulations, the Early Intervention Program. The public comment period ends October 22, 2012.  The new regulations create a requirement for arms-length relationships to tamp down conflict of interest that may be contributing to over-utilization and cost over runs. An arms-length requirement between evaluators and providers is reasonable given the evidence of inappropriate utilization and significant cost over runs in these programs.  Although not all inappropriate utilization can be attributed to this factor, it is ethically correct for providers to remove any possibilities of conflicts.  Existing rules and regulations, whether in professional practice acts or the EI regs themselves, have not controlled this problem Here is a pertinent part of the regulation:    (ii)(a...

The following material was copied from the NYSOTA Facebook page.  A fan of the page (George Nickel) posted a general "calling out" to NYSOTA which prompted my response.  This might be lengthy, but I believe that it is instructive. Post from George Nickel on Facebook: Okay, I am calling you out. We have received written support from The New York State Speech Hearing and Language Association and the Regional Physical Therapy Association but none from the OT regarding the issue of the Related Services Tier System of The NYC Department of Education. Is it not an important issue that children with special needs and their families need you to join with the other organizations to advocate for not just them but for your profession? Christopher Alterio responds: George, this sounds like a local RFP that you lost and not a professional problem. if you have some more detailed information to share I would be interested in seeing it. I looked at various Facebook pages that are ...

OK so I haven't let my inner R. Buckminster Fuller out for a walk lately so I think it is time to address a problem that I perceive with some aspects of clinical problem solving in occupational therapy. Here is some background first: In this month's AJOT there is an article on Proprioceptive processing difficulties among children with autism spectrum disorders and developmental disabilities (Blanche, Reinoso, Chang, & Bodison, 2012).  It is an interesting article that demonstrates differences in test performance on an observational measure of proprioception between children who have disabilities and their typically developing peers. The authors correctly point out that we only have limited means to actually measure proprioception.  The Standing and Walking Balance subtest of the SIPT is a good measure, but like other measures of balance it is confounded by proprioceptive processing, labyrinthine righting, and optical righting.  It is difficult to really know how...

Well I am sleeping better tonight knowing that the Chicago teacher strike is over!!!  All of the really important things like making sure raises stayed in place and health care contributions stayed low got the immediate attention they required.  Muscling out charter schools got a lot of good attention also and of course that is good because we don't want to have competition against a failed school system.  The less important issues like teacher evaluation systems got pushed off into the future. I don't even live near Chicago and I have no skin in that game directly but I just wanted to express how happy I was that those Union efforts will continue to work in favor of students - just like I saw them working in my own community recently. You see there was a four year old child who has a physical disability - doesn't even matter what the disability is exactly so I will leave that detail out - and he was happy and excited to start his school year.  All summer long hi...

This was written in response to Dr. Clark's letter to Pediatrics regarding the AAP Policy Statement : Sensory Integration Therapies for Children With Developmental and Behavioral Disorders.   ++++++++++++++ Dr. Clark's response included some important points which were good to read, including recognition that single modality interventions tend to be ineffective; I am hopeful that her statements will help to move occupational therapy practice away from these interventions. I was also glad to see mention of the neurobiological literature as theoretical backing for some interventions.  This is important literature that we should all keep in mind when trying to understand apparent processing difficulties. Finally I was glad to see mention that occupational therapists use a wide variety of interventions with sensory processing interventions among them but not representing them solely.  I think we need to remind or medical colleagues of this fact lest we bec...

Physics tells us that energy and mass can't be created or destroyed; rather they are transformed from one form to another, at least in closed systems.  My brain can't handle much past Minkowski space so I get a little fuzzy if I try to understand conservation principles in expanding space-time volumes, but then again I am no physicist and I am certainly no mathematician. I've been thinking a lot lately about energy and where it goes when variables are introduced into a system.  A parent began presenting me with a complex pathway of what-if scenarios regarding her child's eating skills - what would happen if this occurred, and what would happen if that occurred - and she had the entire child's trajectory imagined before a single bite of food made it past the child's lips.  There was no pause along the trajectory to map out the potential energy within the system (that might subsequently be transformed to a different kinetic pathway) because the parent already ha...

I was reading the Medscape Oncology pages today.  I received an email notification about a series of articles on palliative care and most of them were quite good.  There was a particularly interesting perspective on DNR choices and showing patients (who have terminal disease) CPR videos and how this impacted their choices for end of life care. I started thinking that this was good information.  Then I started thinking that it is information that could be bureaucratically abused.  It worries me when I start seeing people use the word 'economics' next to 'end of life care.'  I think if we focus on quality issues and as long as we are honestly looking at quality issues then it is all ok. Anyway, I started clicking around and then I stumbled across an older article and video about how doctors need to understand the needs of care providers.    I thought that it was a kind message and in watching the video portion I was thinking that Dr. Marshall seemed...

I've been reflecting today on my belief that small things matter. This first came to mind when our current OT student intern jokingly commented that we almost lost another puzzle piece - which is justification for disaster alert at ABC Therapeutics because I kind of have an unhealthy obsession a value for keeping puzzles complete... We recently had a celebration when we finally found the beloved monkey that was missing from a puzzle for so many months. So anyway I am glad that we don't have that many missing puzzle pieces because even though it is a small thing I have the belief that it matters.  The concept was reinforced when our OT student intern was able to open the door today - she has struggled with the 'child safety cover' on the door handle for her entire fieldwork experience.  This afternoon she opened up the door on the first try and at the same time we both cheered, "HOORAY!"  Again, it is a small thing that matters. I have also been thi...

I received an email yesterday from an anonymous commenter who wanted to know what one of my actual days looked like as a private practitioner.  So here goes a listing of what happened today, which seems as representative as any other day :D : 4:30am Wake up.  Read email, respond to email.  Check local and national headlines, reading 1-2 articles of interest.  Check Internet forums, respond to messages.  Look at clock and sigh. 5:15am Go back to sleep.  7:15am Wake up, again.  While having breakfast read email, respond to email.  Complete a journal and focused medical news scan, reading 1-2 articles of interest. Check Internet forums, respond to messages.  Look at clock and sigh. 8:30am  Wonder why children are still sleeping, pay attention to the cat and dog, leave for the office. 8:50am Arrive at office.  Meet with parents in the waiting room while their children are in for therapy.  Banter, advise, support. ...

As I blogged about earlier this year, there were some problems with the changes to the NY State occupational therapy law that placed significant barriers to non traditional fieldwork settings.   OTA fieldwork educators in New York State and NYSOTA saw these problems and there was a last minute rush to file a technical amendment to the law so that they would not have to operate under such restrictive conditions. It is true that the way the law was written could have contributed to a decreased pool of practitioners able to accept fieldwork students; OTA students would have had to compete with OT students for licensed occupational therapy supervisors.  Fieldwork educators already struggle to find 'slots' for their students and the law certainly did not help by imposing restrictive limits on WHO could supervise a student. However, restrictions are in place for a reason - namely to protect the public - and both Medicare and Medicaid have rather severe restrictions that function...

Over the last month there have been several stories in the news about the shared 'decision' to close down the Ridge Road Intermediate Care Facility that is operated by Baker Victory Services.  The 'decision' was actually prompted by conversations between the NY State Office for People with Developmental Disabilities (OPWDD) and Baker Victory administrators.  In the recent past there have been reports of problems at the Ridge Road site including failures in quality of care. New York State monitors performance on quality indicators of these facilities.  In June 2011 Baker Victory Services was placed on Early Alert Status for deficiencies in care and this was followed by imposition of a $2000 fine in January 2012 due to ongoing concerns. It is difficult to assess how serious the violations are without more direct knowledge of the findings.  Of course any dereliction of responsibility to provide proper care is a concern, but family members of those housed in the fac...

Corporate practice and the health care professions in New York State might not be on the top of everyone's interest list but there are some things that professionals and the public need to be aware of.  In New York State and in many other states for that matter there are restrictions on who can hire professionals to provide services.  These kinds of laws prohibit any random person from starting a corporation and hiring OTs or PTs or any professional and billing for those services.  The reason why those laws exist are because people think that there is potential for abuse/fraud/unethical choices when professionals are not 'owned' and 'supervised' by people within their own professions. Now of course just because an OT hires and OT or a PT hires a PT that does not guarantee that unethical things won't happen.  Still, there is generic concern so these laws were enacted to prevent abuse.  So, in order for PTs and OTs to both be hired by a corporation there needs...

More for the file 'whose kung fu intervention for autism is strongest.' Lang, et.al. (2012) published a systematic review of sensory integration therapy for autism spectrum disorders that at the same time has academically dishonest and potentially useful information. The review errs in its rather lopsided inclusion of articles that measure the effects of isolated intervention strategies that would probably best be identified as addressing components of sensory processing as opposed to measuring a sensory integration methodology.  This is nothing new; there have been some good articles in the American Journal of Occupational Therapy recently that have contributed to debunking the use of seat cushions to promote attending behaviors and debunking the use of weighted vests to promote attending behaviors.   These findings are yet to filter into practice because a lot of people really like the idea of quick and easy answers to complex problems.  Finally we are getting to a...

There was an interesting conversation on the AOTA forums recently about whether or not a COTA should be 'bathing' patients in a nursing home. Some of the conversation centered around the 'skill set' of the COTA and whether or not the COTA was being used in a nursing assistant type of role.  Then there was discussion about whether or not this was appropriate, and some people thought it might be appropriate as long as it wasn't being billed out as direct occupational therapy (unless there was some therapeutic self care training aspect to the task). Most of these points were valid - but as is typical in online forum posts there is a real lack of detailed information so it is almost always near impossible to know if any answer provided is really the best answer for what is being 'asked.' Something else jumped out at me though while I was reading the conversation.  Someone said, I say not bathe the patients because that is not what they went to school t...

What motivates a memo from your government? Today I was sent a memo from OPWDD that addresses the issue of interagency coordination between the Office for People with Developmental Disabilities (OPWDD) and the Early Intervention Program in NY State.  Why are they motivated to better coordinate services between governmental agencies?  Simple answer, if you read the news. Costs for special education services are soaring in New York , as documented in this NY Times article.  Quasi-privatization comes at some cost, which really can't be denied.  If you want to get depressed go and read some audits from the State Comptroller's office.   If you are less motivated to read these audits then just watch the news and you will see several articles like this every year.   In sum, there are bad eggs out there who are gaming the special education system at taxpayer expense. The problem with the Times article AND the problem with the resulting memo from OPWDD is t...