ABC Therapeutics Occupational Therapy Weblog

I saw my first patient 20 years ago, and at that time the debate was raging over whether we should call the people who we work with 'patients' or 'clients.' I don't know that there was ever any 'official' decision made, but now we see patients, clients, students, workers, etc. I usually use the term patient, which is mostly out of habit. When you work in a single field for 20 years you can be accused of being 'old school' and old habits die hard. But I didn't choose to write tonight about semantics. I was thinking back to my first patient contact 20 years ago because that is when I learned about people who have cancer. When I am struck squarely between the eyes with a proverbial baseball bat I automatically start working from the beginning of my experience to remember what I have done before, seen before, experienced before. My experience is my crutch, like an old man's walking stick. A former patient's mom emailed me today and told me t...

All I do is write, but not here. This evening I cranked out about 18 pages worth of evaluations. That is single spaced technical reporting. My hands are numb. I've been spending a little time thinking about what I am choosing to write lately and what I am not choosing to write. There is a story I needed to record - and I will only put the snippet here for memory-jogging purposes, but there was so much behind it. I have been considering the nature of disability, particularly as it relates to children. It is hard to be disabled as a child because so many people do so many things for you ANYWAY. The standards are just not the same as with adults. Example: if an adult has a stroke and can't dress themselves, they are considered disabled. If a child has a stroke and can't dress themselves, the parent provides care. Because children are children, and because parents do what they do, the concept of disability is different with kids. Hmmm. Well a parent asked me an interesting ques...

I saw a posting on my discussion forums from a previous student; she was talking about her experiences working in pediatric critical care. I am sure that she does an excellent job; she was a very competent student. I am still recovering from my pediatric critical care experience. Here's a story that is stuck in my mind, despite it happening nearly ten years ago. *** Transference is an old Freudian term that refers to the unconscious redirection of feelings. I didn't know Mandy for very long, but I felt that I loved her the moment that I walked into her room. This little girl was just six years old, beautiful and blonde - she could have been my daughter. So when I saw her I felt love for her. When I walked into Mandy's room I also felt an immediate sense of deep and profound sadness. She was lying still in the bed, eyes defocused toward the ceiling, and not responding to anything. In a corner of the room I saw a man who I imagined was her father. His eyes were just as dista...

I mentioned a couple months ago that I would be an astrophysicist if I wasn't currently practicing as an OT. Actually, I lack the mathematical ability to do this kind of work seriously. Despite this, in my ongoing attempts to enlighten myself on the nature of the universe I went and listened to a Brian Greene lecture this evening. This actually does have something to do with OT. This has to do with our choice of occupations and the impact that it has on our world-view. I have a General Systems Theory Knowledge Map hanging on the wall of my office. I keep it there to remind me to think expansively, but the bottom end of the Knowledge Map is a little outdated - I think it lists atoms or perhaps just quarks. Tonight the lecture was about strings, of course. It was interesting, but perhaps not as technical as I was hoping to hear. Actually the most important part of the evening to me was listening to the questions that people asked him. There were some very hostile questions, although ...

I watched the young boy approach the table at the farmer's market. He was only 8 I figured. Maybe 9. His hands reached immediately for a ball on the table. It was oddly shaped so that as it 'rolled' it would go in unpredictable directions. The young boy looked at the 75 cent price tag and dug deep into his pocket. He smiled, excitedly: he had enough money. Still, he seemed to pause. I imagined that he was trying to decide. Is this what he would spend his money on? "My son and I spent hours and hours playing with that ball," announced an adult voice from across the table. "We would play with that ball for hours. It was the most fun we ever had." I don't know how to convey the true intent of this man's statements. I am sure that I heard something very different than the little boy. I heard a professional farmer's market pitch-man, trying to eke out another sale. The little boy's eyes lit up. This statement made his decision easy. He quickly...

In an ongoing attempt to develop a (hopefully expanding) understanding of childhood occupations, I offer this self-reflective entry. In it I can find the dynamics of interpersonal interaction, the rule-making and gamesmanship that hopefully leads to participatory democratic thought and action, and of course meaning that transcends time. All interesting, when you consider it was just a childhood collection. *** Young children enjoy collecting things. Bugs. Baseball cards. Comic books. Rocks. Lincoln pennies. My brother and I collected bottle caps. I am thinking that Gary, one of my earliest school friends, was the first one to have a bottle cap collection. His Dad worked for the government (we weren't allowed to know what he did - and to this day I still don't know) and he went to odd and exotic places around the world. Their living room was decorated in a Japanese motif - and Gary's Dad brought back bottle caps from Japanese beer bottles. That got us all intrigued. As ten y...

I provided expert testimony last week in a state Supreme Court case. A municipality is suing a family because they keep three goats and a llama on their property for purposes of 'animal-assisted therapy' for their child who has autism. The family purchased the property (previously used as a horse farm) thinking that they could keep these animals on the premises. It turns out that the land was re-zoned and the previous owner's animals were 'grandfathered' but that the land use restriction came into effect when the property was sold (unbeknownst to the family who has the autistic child). They had these animals for over ten years and the child does derive some benefit from interacting with them. My testimony centered around the child's condition and the use of animals in a therapeutic context. The child interacts appropriately with the animals, enjoys 'pushing' fights with the goats, and it is one of the few purposeful activities that sustains his attentio...

Willowbrook State School was the pride of Governor Rockefeller's Mental Hygiene program. In the early 1960s it was the largest residential facility in the nation for people with mental retardation. Willowbrook Director Dr. Berman wrote in the Staten Island Advance that Willowbrook had "approximately 6000 patients, more than 1800 employees, and 24 patient buildings..." Governor Rockefeller developed the 'New York State Institute for Research in Mental Deficiency' on the Willowbrook grounds. The 'gem' of Willowbrook quickly lost its luster. In 1965 US Senator Robert Kennedy toured the facility and stated that "Particularly at Willowbrook we have a situation that borders on a snake pit and the children live in filth. Many of our fellow citizens are suffering because of the lack of attention, lack of imagination, and lack of adequate manpower. There's very little future for the children or those in this institution..." People who had developmenta...

I spend my time thinking about the topic of writing as occupation and whether or not it carries any therapeutic benefits. Here is an interesting article that caught my eye: Writing helping young Katrina survivors . I'd love to discuss these ideas with other people, so here are my thoughts - if anyone is interested. Why would people be interested in the private writings of another person? Bunkers and Huff (1996) explain that "diaries are not so much inclusive because they contain everything from a given day, as they are inclusive in the sense that they do not privilege 'amazing' over 'ordinary' events." This celebration of the ‘ordinary’ is a longstanding theme in understanding meaningful occupation. Diary writing and diary reading provides a vehicle of social connectedness through the ordinary. This is a human need and is the basis of interactivity between the writer and the reader. The use of the diary as an interactive tool provides an example of what Ro...

I was invited to teach a class at Keuka College. I used to be on the faculty there so it was something of a return for me. Although I thoroughly enjoy what I do, I have to admit that I miss teaching. The students were leaving the room, and I sat in the front of the class as is my custom and I watched them as they moved on with their day. Then they were all gone. As I turned out the lights in the room where the students had been just a few moments earlier, I felt a little sadness that I was alone. I considered how the room had been busy and full of chatter and even some excitement. We were learning about evidence based practice and early intervention. As I sat alone in the room, on a mat table in the corner, I remembered Stephen. Stephen was probably the most learning disabled child I have ever worked with. This will undoubtedly be very difficult for anyone to understand who does not know about learning disabilities. These kids walk and talk and superficially appear just like every oth...

I had a busy day today. I feel like expressing the daily variation in my clinical responsibilities. These are all single-frame descriptions. If you read them quickly, maybe you will see me moving. Is this the nature of disconnected discourse? How can I make this 'real' for you? My first task was to attend a planning meeting for a young child who has high functioning autism. He just transitioned into a kindergarten classroom and the parents asked me to participate. I have known this child for two years and had some input that was hopefully useful to the educational team. This meeting went well. Phew, they don't always. Next I had a phone conference regarding a 4th grade child in a distant school district. The family traveled a great distance to see me and I spent a full day (a couple weeks ago) completing one of our infamous 'intensive' evaluations. This CSE meeting also went well, so I was feeling pretty lucky at this point. Then I drove to see a little friend, just...

I’m in Chicago tonight. This is my last bit of travel for the rest of the year. I never expected to have to travel much when I chose this occupation, but this year alone I have been sleeping in hotels for over 40 nights, not counting three weeks of vacation this year. In other words, it is good that I work for myself because no employer in his right mind would ever tolerate this. In fact, if I wasn’t so invaluable to the organization I would probably fire myself. This is the insanity speaking; it was that kind of a day. I saw a group (not really enough to call them a flock) of seagulls today while driving to the airport. No big deal, except that they had located themselves in the middle of some completely landlocked farmland. Not a speck of water in site: no major rivers, no major ponds or lakes around for miles. And certainly not the ocean. Although to be technically correct I guess there is no such thing as a 'seagull.' I whipped out my Peterson's field guide and saw that...

I am having one of those days where I am not communicating clearly. At first it was just at work but in preparation for this entry I found that I also can't communicate with my own children. While taking the picture above I was having a hard time finding a suitable background that had enough light but not too much glare. I said to my daughter - "Go find me something that I can use as a backdrop that can absorb some of the light so I don't have so much glare. She gave me a sponge, obviously interpreting 'absorb' a little too literally. Note to self: daughter needs basic lesson in physics of polarization. *** Today I was working with Adam, who is a wonderful seven year old boy with superior intelligence and some gross motor delays. After some vigorous activity using the suspension equipment, I thought it would be a good idea to transition him back to his parents with a quiet activity so he wouldn't be bouncing around the car during the ride home. "Let's ...

Cameron was not impressed to see me. He had been kicked enough, I was sure, and did not need to have some other adult come into his life (only to leave, eventually). Still, his cardiologist wanted me to see him, to get him out of bed, and perhaps to do a little 'attitude de-funking.' Of course the script wouldn't say that exactly, but that is what the doctor asked me to do with him. Cameron was spending most of his time in bed, and it was complicating his status on the heart donor list. He was born with a rare condition called transposition of the great arteries - basically, the plumbing in his heart was all mixed up. He had gone through several cardiac surgeries in his life and there really was little else that the surgeons could do except wait for a new heart to come along. The problem was that Cameron was just wasting away in bed, and his inactivity and poor nutrition were complicating his immune status, and this in turn could have potentially compromised his ability to ...

I received an email earlier this week, asking me 'why' I write here. That was a hard question. Interacting in people's lives every day makes me think of so many stories, and sometimes I am not sure where to begin to make sense of it all. Writing them down helps me to understand them in the present, just long enough sometimes to begin to understand. T.S. Eliot wrote: At the still point of the turning world. Neither flesh nor fleshless; Neither from nor towards; at the still point, there the dance is, But neither arrest nor movement. And do not call it fixity, Where past and future are gathered. Neither movement from nor towards, Neither ascent nor decline. Except for the point, the still point, There would be no dance, and there is only the dance. Writing helps me to understand the dance.

I had the privilege of observing a child in their school this week, and I spent a few hours watching the typical routines of the classroom. I was a little surprised at the amount of information that some of the kids shared with me. I love talking with children. They interest me, generally far more than adults do. What I like best is that there can be gaps in the conversation and you can drop a subject or pick up a subject easily. I think I also appreciate the eye contact that children give me - which is generally more than adults do. Lots of adults don't stop to notice that kids are really good at visually attending to a conversation. I think they are often too busy talking to other adults, or they are above the eye level of the kids, or just too preoccupied to notice. Anyway, Rachel had me enraptured. She is one of the children in the class, and her eye contact was just so wonderful while we talked. I also caught her studying me several times during the day so I would smile at her...

I hope that everyone has the opportunity to read the latest study about child pedestrian safety. I have the press release, report, and safety tips available for download on the ABC Therapeutics website in the 'NEWS' and 'RESOURCES' sections. Nationwide, pedestrian injuries are the number two cause of accidental death among children ages 5 to 14. Each year in the United States, approximately 650 children are killed and 43,000 treated in emergency rooms as a result of pedestrian injuries. The total annual cost of traffic-related pedestrian death and injury among children ages 14 and under is $5.2 billion. We haven't gotten many calls on this issue - but hope that this will begin to raise awareness!

I am reduced to recycling my writing - but I have abused my responsibility to write in here so I feel the need to fill it up... I could focus on writing more if... (I won't bore anyone with excuses). Because I have been so chipper and upbeat lately I decided to take a drive through a former toxic waste dump. Don't ask me why; I have no answers. I don't live near this place, but it is not far to drive. Everyone has heard of Love Canal, but I felt some compelling reason to visit today - I have never been there before. Perhaps this was prompted by someone giving me directions to their home recently. "It is on such and such street, but not on the Love Canal side." She said it with a conviction, and a hope. I didn't understand, so I decided that I better visit the Love Canal side of such and such street. I hang out in Niagara Falls way too much. I have done some amateur anthropological studies, based on narrative searches for truth about why it is the way it is. I ...

"You think I'm licked. You all think I'm licked. Well, I'm not licked. And I'm going to stay right here and fight for this lost cause. Even if the room gets filled with lies like these..." I am in Washington, DC tonight. As part of my ongoing doctoral studies I am participating in some lobbying efforts to repeal the payment caps that were placed on Medicare Part B outpatient rehab services as part of the 1997 Balanced Budget Act . Since 1997 the caps have only been imposed for 3 months in 2003 because Congress passed moratoriums delaying the impact of the caps. Unless Congress takes action again, the current moratorium will expire on December 31, 2005, and the caps will take effect on January 1, 2006. The caps limit Medicare coverage to $1,500 for occupational therapy. What does that mean? Basically it means that people with Medicare will have limited access to OT, and it means that other insurance companies will be likely to follow suit. That's not good f...

It started out as a good day... I was having a little tooth sensitivity yesterday, but I mostly ignored it and tried to focus on the many tasks at hand. Life is busy as a pediatric occupational therapist in September. Then I jinxed myself. This morning my sister mentioned that my niece was having some pain with her new orthodontia, so my wise comment was - "Well when they find bones in Olduvai Gorge the most common bones they find are jawbones and teeth - which is proof that these structures are built to last and are not designed to be moved." I should have kept my mouth shut, literally, because I scheduled a visit to the dentist to have my own tooth sensitivity looked at. The dentist decided to pull my offending wisdom tooth, which was quite an experience. It didn't want to be separated from my jawbone, and it was in fact ankylosed. This interested me, because I never before considered that teeth could be ankylosed. The dentist's brow was beade...