Showing posts from April, 2012

Occupational therapy blogs you must read.

This weekend I participated in a presentation with four OT colleagues at the AOTA National Conference in Indianapolis.  Conference can be a little stodgy at times- but not with this group! I want to publicly acknowledge the OT Social Media Awesomeness of this group of people who obviously know how to have fun and be awesome/inspirational/educational at the same time: Cheryl Morris: When I saw Cheryl's level of extreme organization and skill in managing multiple information sources and easily coordinating a cascade of incoming information I was just amazed.  Then I wanted to hire her to help me organize my office!  She was the glue of the group and did a fantastic job getting it all initially coordinated. Anita Hamilton: OK, so when I met Anita she was in her pajamas, effectively modeling the garb that could be used to conduct a groundbreaking and worldwide online occupational therapy conference ( from

On tin foil hats and sensory integration

There was an open forum at the AOTA conference in Indianapolis so I took the opportunity to raise a question about the profession's advocacy regarding research on sensory integration. My comments were: I appreciate the advocacy offered by AOTA regarding the situation in North Dakota where a coordinated letter writing campaign contributed to a BCBS intermediary indefinitely holding a decision that would label sensory integration as 'investigational.' However, it is true that Cigna, Aetna, United Healthcare, and nearly every other BCBS intermediary labels sensory integration as an investigational intervention. Additionally, the National Autism Standards Project and the NY State Clinical Practice Guidelines for Early Intervention also labeled sensory integration as investigational. With so much of the larger world identifying something as investigational, is it possible that AOTA places its members in an awkward position by continuing its advocacy without a more tempered a

How CPSE to CSE transitions are being handled in some districts.

I just saw a flyer from a local advocacy and educational center about a seminar they are offering for parents about the transition process between CPSE and CSE. This is a very good group and they provide valuable services to parents, but I was wondering if they would describe the transition process in terms of how it SHOULD be or how it ACTUALLY IS. Here is a review of how it ACTUALLY IS for many parents who are unlucky enough to live in certain school districts. In February a school asks all the related services people providing OT, PT, Speech, etc. to give their opinions on whether or not a preschool child should be considered for CSE referral. The school compiles these generic opinions and based on some unknown decision making process sends some of the names over to the CSE for consideration. Then a giant wall is erected and there is never any additional communication between the CPSE and CSE. Sometime in March or April I get requests from CSEs to participate in these meetings,

Thoughts on the validity of subtypes of sensory processing disorder

There is a study that was announced this week by the Sensory Processing Disorder Foundation about classification of sensory processing differences in children (James, et. al, 2011). The study describes a process of using cluster analysis to differentiate subtypes of sensory processing disorder. Results of this study indicate support for the empirical nosology proposed by Miller, (2007). Schaaf and Davies (2010) explicitly talked about the need to careful consideration while we are refining and redefining sensory integration or sensory processing concepts. In their article they commended Lucy Miller's group for advancing the theory but at the same time called for empirical evidence to support these concepts. The James, et. al. article seems to be a response to that call. Of significant concern in this new cluster analysis is that "a high percentage of our sample displayed behaviors characteristic of ADHD and similarly a high percentage of children who met criteria

When life is too full: Social and cultural impact on parenting practices

During a lecture that I was giving to students yesterday I found myself rattling through a list of gross motor and fine motor play experiences that OTs might suggest to parents and how these activities would promote normal sensory motor development. I started thinking to myself that it was odd that we are socially and culturally in a place where we have to 'teach' some parents about how to promote children's play. The truth is that some parents really do need help to understand how to promote normal development - and in part that is probably because we have new social and cultural practices that separate families from each other and relegate care of children to non-family members. Some families are able to deftly balance all of the conflicting social role expectations and requirements of jobs, parenting, maintaining family balance, etc. Others struggle mightily. I just did a quick blog search to see if I have ever told the story of the "mom-ager" and I couldn&#

Sensory integration and insurance coverage

My tongue-in-cheek commentary on fidelity in sensory integration and coverage for geriatric SI has generated a lot of email questions: a lot of people wanted to know the policies of most insurance companies. Obviously the insurance company I was poking fun at was covering something that they are calling sensory integration but I am not convinced that their definition matches that of many other people. Here is a summary of the sensory integration policies of the largest health insurance companies in the US: United Healthcare policy Sensory integration therapy is unproven for the treatment of any condition... The available studies of sensory integration therapy are weak and inconclusive and derived primarily from poorly controlled trials with methodological flaws. These trials fail to demonstrate that sensory integration therapy provides long-term improvement in neurological development and behavioral development. There is no reliable data from well designed clinical studies that indi

On the Great Frontier and Trendelenburg gait patterns.

The morning was ticking slowly by, which suited my needs and my mood. I am generally at peace with the passage of time. Answers don't always happen quickly - but I like to be ready when they do happen. I have learned to be patient when I am confronted with clinical problems. Sometimes it takes a while to get to a distant destination, and progress is more easily measured by movement toward goals than by the passing of some arbitrary measurement of abstract time. But then like a flash there will be a change, and sometimes you just have to frame a problem a certain way in order to find a good solution. That is what I have been thinking about all morning ever since Sandy left. Sandy is five years old has left hemiplegia which causes her to walk with her left arm flexed above her shoulder so that her hand is almost touching her ear. Her left leg is stiff and she has a Trendelenburg gait. She is receiving physical therapy but her gait pattern is becoming habitual. She still has hi