Showing posts from August, 2012

More discussion re: the AAP Policy Statement on sensory integration

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 become as

How to solve children's complex feeding difficulties.

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 have no title for this

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 like a very kind

I believe that small things matter

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

Occupational therapy private practice: A day in the life

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.  Repeat as needed.  Schedule meetings to resolve lingering issue

Special interests drive language changes to OT Assistant laws in NY State

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 functiona

Challenges with the care of people who have developmental disabilities: A case study of recycled history in Western New York

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 facili