Showing posts from February, 2009

The equivocal value of (some) school-based occupational therapy

Occupational therapy, at its best, is a change-enabling service that helps people accomplish goals that are personally meaningful and relevant to how they occupy their time. For kids in school, this means being able to learn and socialize and develop skills for future citizenship. Therapists routinely wring their hands over issues of eligibility criteria for said services and balance this out against spoken and unspoken procedural rules that are generally applicable only within their own school systems. The interesting aspect to this is that any given school based OT will then believe that the way THEIR school district operates must represent the way that ALL school districts operate (and for that matter, how they are SUPPOSED to operate). Those of us who have the opportunity to interact with dozens or scores of districts across wide geographic areas have wider exposure to the variety of ways that districts interpret presumably identical criteria and rules. Twice this year I have th

Central convolutions to itch and scratch in sensory processing of pain

Convolutions have always been interesting to me - and that is the way that I have always tried to understand the complexities between itch and scratch. I think I slept through any references to Fourier analysis that I was ever exposed to though so I am kind of weak on applying a mathematical model to the problem - even though I think that is the best way to consider the relationship. This is why I am an occupational therapist and tend to keep myself in application/behavioral analysis - because as soon as I dunk my head into the literature of molecular pain I start to get a little lost. I find some solace in the knowledge that even the molecular pain people are still figuring it out though. Itch and pain are oddly connected. Histaminergic systems seem to be square mediators between these two sensations. In conversations with OTs I have heard people talk about local histamine release associated with brushing - but this always seemed (to me) like it was an overly simplistic way to exp

Thick descriptions of occupational therapy ADL intervention: A case study.

The context for this entry is that there has been some debating lately about what constitutes occupational therapy and if it can be represented by symbols or even words. So file this entry under: "An example of when the story probably works a little better than the image." Caleb is thirteen years old and he lives in a shack on the east side of the city. His father abandoned the family long ago and his mother has been on disability payments for as long as she can remember. It's a little difficult understanding the full story because all of her teeth are missing and her articulation isn't particularly clear. That could be part of the reason why Caleb has speech delays - because the voice that he has heard since infancy, although loving, is like listening to marbles rolling over white noise. Caleb has a moderate degree of mental retardation for which there is no specific cause. It could be genetics and it could be environmental but it is likely both. He relies on

Issues with occupational science and the developing lexicon related to occupational or social justice.

The concept of occupational justice is in its infancy, still struggling with definition and identity. Although many of the concepts associated with occupational justice are not new, they are being evolved and reaffirmed, representing another step in the scientific (r)evolution of occupational therapy. Clarification of salient issues has to include definitions of assumptions, concepts, taxonomies, and subsequent research orientation; these are all critical for the evolution of concepts. The primary challenge in developing a lexicon for occupational science is one of linguistics. Some linguists argue that a concept must be encodable in order for it to be stable. This is important so that the 'hearer' can understand and form a mental concept of the message. However, other linguists argue that there are more concepts than there are encodable forms. Additionally, it takes time for words to stabilize within language. This seems to be the state of affairs in occupational s

Reflections on the 'branding' of occupational therapy

Also file under: Nel mezzo del cammin di nostra vita mi retrovai per una selva oscura, che la diritta via era smarrita. (because when all else fails, read Dante). With some pain, I have been watching the wheels fall off the branding bus over on the OT Connections site. AOTA kicked off a new branding campaign in the last year - starting with an unveiling during last year's annual conference and recently represented by the release of a rather odd poster that is being alternately described as wonderful or horrible, depending on your individual opinion. In response to some of the questions and constructive criticism, AOTA President Penny Moyers writes: When we read the literature about OT, it is not really about simple engagement back into doing. The essence is about meaning, quality of life, satisfaction, health and well being that comes from being able to participate in a life that is full of potential, regardless of the barriers. We no longer confine our intervention to those with

Stream of consciousness on being a Witness

This post deserves an update - because as I have stated these stories do not end. You may also want to reference this partially related rant for background. I received a subpoena to appear in Family Court regarding the case linked to above and I sat, dutifully, waiting to be called in. I was a little surprised to receive the subpoena because my documentation excoriated the Child Protection system as much as it did the family. Still, if someone actually wanted to hear me tell a story I was more than willing to do the telling. My faith in these court hearings is minimal - I have been to some and had the defense attorney make fools of CPS and been to others where the children were removed from the family home as was appropriate. The problem is that you never know what you are going to hear and see before they start. Rules of evidence are tricky - and at the same time I appreciate their complexity. I really do hate the concept of an oppressive state that can remove your freedoms but