ABC Therapeutics Occupational Therapy Weblog

Christopher J. Alterio, DrOT, OTR Jennifer Welninski, OTS Danielle Green, OTS Lauren Martin, OTS Christopher J. Alterio, DrOT, OTR is owner of ABC Therapeutics in East Amherst, NY and directed the study. Jennifer Welninski was a student at D’Youville College and assisted in research design and proposal writing. Danielle Green was a student at Quinnipiac College and assisted in data collection. Lauren Martin was a student at D’Youville College and participated in data collection. All students participated in this research project as part of their Level II Fieldwork experience at ABC Therapeutics. The research project was conducted during 2007. Statement of the Problem Howda Designz created a seat product for adults and children that is being used by schools and parents nationwide. Anecdotal evidence supports claims regarding the benefits of using the seat. However, higher level clinical evidence is lacking. This company is a small business and they lack sufficient resources to conduct c...

Over two years ago I wrote this article about continuing competency regulations for occupational therapists in New York State. Based on a review of the status of proposed regulations for continuing comptency as reported by the New York State Assembly website - there has been no action on this bill and it seems to be 'stuck' in the Higher Education Committee. The idea behind this proposed legislation would be to improve consumer protection by mandating that occupational therapy practitioners in New York State participate in some mandatory continuing education. As of right now, the therapist who is treating YOU in New York State may have graduated thirty years ago and never taken a continuing education course. Interestingly, a law requiring physical therapy continuing education in New York State was signed by Governor Patterson only a month ago. Since that time I have scoured the Internet and NYSOTA website for word on the OT continuing education bill and have not found anything...

I thought this would be a fine opportunity to begin publishing snippets and reviews of my writing. This page will be dynamic and updated as new comments or reviews are received. "...self agrandizing (sic) blah-blah." - Dr. Jane Sorensen, 8/2/08, Advance for Occupational Therapy Practitioners website, regarding my comments on discussion regarding this article that she authored. edit 10/10/08 This was a very flattering find at http://theamazingworldofpsychiatry.wordpress.com/2008/10/10/blog-review-abc-therapeutics-occupational-therapy-weblog/ : The featured blog is ABC Therapeutics Occupational Therapy Weblog by Chris Alterio (who works in New York) and is in my opinion outstanding. Alterio’s writing is clear, intelligent and engaging crossing over from the nuances of clinical practice through theoretical discussions around diagnosis to the intricacies of neuroanatomy of clinical conditions. In this scholarly article on foster care, Alterio discusses its impl...

Here is a response from Dr. Sorensen, published on the Advance for OT website at http://occupational-therapy.advanceweb.com/Article/Who-Should-We-Be-Treating-in-EI.aspx I would like to re-post her comments in full - even though my intent is entirely Fair Use - but I don't want to be squelched by powers who don't like the debate. Go to the link quickly before it disappears. If Dr. Sorensen would like to grant permission I will post her comments in full on this site. Dr. Sorensen asks that people go to http://www.pediatricservices.com/prof/prof-01.htm which she believes is an article that will 'validate your clinical experiences.' This article quotes several health care professionals who question the life-saving measures and efforts that are afforded to critically ill infants. For the second time this week I am deeply disappointed in Dr. Sorensen's opinion. This article is a gross misrepresentation of what happens on a daily basis in neonatal intensive care nurseries...

Dr. Jane Sorensen wrote an opinion piece in the most recent Advance for Occupational Therapy Practitioners where she muses about which populations of children are best served by occupational therapy services. This opinion piece is one of the most disturbing that I have read in a while. Dr. Sorensen suggests that functional outcomes for severely disabled children are no different when they receive services from skilled professionals as opposed to when they receive maintenance care from people who are less-skilled. She states that occupational therapists should "focus away from the very disabled child and give treatment to those who have a chance in leading full or nearly full functional lives as adults... Let the less-skilled personnel focus on the least functional patients with the poorest prognoses. I think we would be more creative, could get more attention and respect as a profession if we would treat babies who will eventually enter into and take part in the mainstream of our ...

I attended a meeting today in support of a child receiving occupational therapy to develop accommodations to the middle school curriculum. A school-based therapist completed an occupational therapy evaluation and it contained many assessments that are generally appropriate for children of that age. The school based therapist did not believe that the child qualified for occupational therapy. The child is 12 years old and the evaluation included the Developmental Test of Visual Motor Integration, the Motor Free Visual Perception Test, and portions of the Bruininks-Oseretsky Test. By all of these measures the child was functioning within appropriate developmental parameters. The school OT reported that the child could write legibly, could change for physical education class, and manipulate all school materials functionally. So why was I recommending accommodations to the middle school curriculum?? It is true that the child had excellent grades and good handwriting - but these were not the...

Edmund Burke's call to arms is apparently lost on some Illinois occupational therapists, at least according to the cover story "The State of EI Practice" in the current Advance for Occupational Therapy Practitioners . According to the article, some OT practitioners in Illinois are more concerned about not offending their referral sources than in securing the safety of the children in their state who need occupational therapy services. That's a pretty hefty charge. I wonder if it is true. Well now is the time to step up. If there is unsafe practice going on in Illinois and if there is encroachment on the occupational therapy practice act by untrained and unqualified 'developmental therapy practitioners' then I expect to hear a hue and cry from concerned practitioners in Illinois. And if there is silence that will also 'tell' us a lot - that either there is no problem, or that OTs in that state are willing to abdicate their responsibilities because (acco...

I was ranting about the sad state of the Child Protection Service in NY state in this recent post that you may choose to reference for background reading. I am still assigned to that case and the living conditions continue to be unacceptable for children. The lack of basic hygiene places the children at risk for health problems and it also makes for an unsuitable environment to provide any kind of developmental therapy service. I just continue to document all of the issues but my hopes sometimes falter. In a completely unrelated case one of my therapists was providing occupational therapy to a four year old in a family home. It is not easy finding therapists to work in urban conditions because to be honest it is a cultural issue and many therapists don't know what to do when they are faced with an environment and culture that radically departs from their own experiences. I know that people take classes and talk about the importance of cultural diversity in college, but trust me peo...

This is a blog entry for Halloween, but I just couldn't wait. My daughter was recently assigned some Edgar Allan Poe to read - and I immediately assumed it would be one of his most famous poems or short stories. I was surprised to find that she was assigned one of his more esoteric stories which of course caused me to launch into a lecture on the state of education today, blah blah blah - you know, the kind of story that makes teenage daughters roll their eyes. I told her that additionally it was important to read 'classic' Poe and referred her to "The Raven" and "Annabel Lee" and "The Tell Tale Heart" and "The Fall of the House of Usher." Then I thought I better read them all again myself so I can talk to her about what I just asked her to read. It had been years since I picked up Edgar Allan Poe... I found quite the surprise while reading these old Poe classics! Mandatory reading assignment for today is "The Fall of the House o...

I don't have time to do it all by myself - I wish I did. Some days the ideas come flying out of my brain so fast I don't know what to do with them. Anyway, my idea of the day is for someone to complete a qualitative study of occupational therapy student's occupations. What could make this interesting? Use Twitter. Bring Mihaly Csikszentmihalyi's data collection methods into the 21st century! So anyone who is interested can email me proposal ideas they are willing to share - I will create a network of interested people via discussion group, and we can establish recruitment and data parameters and create a really large dataset of daily occupational therapy student occupations. It is a learning tool and a way for us to explore how to use technology for data collection. Maybe someday the model can be applied to other populations, but for now I have a working assumption that a fair number of OT students are Twittering. Or if you are an educator and want to try this as a clas...

We talk here a lot about evidence based practice, the need for better science in our assessments and intervention, and professional responsibility to make sure all these things happen. On a daily basis we work toward a better 'science' of occupational therapy while at the same time maintaining a close connection to our 'art.' After all, we are often talking about our connections with real people and how we can best offer help. I feel that we are making some changes in the way we think about these issues in our profession, because I hear more and more people talking about real participation and our goals of assuming or resuming normal occupational behaviors. I've been thinking about this topic all week, and now I am kicking myself twice for not going to the national conference this year. Through the grapevine I am hearing about Dr. Wendy Coster's Slagle lecture and how she talked about measurement issues. I wish I was able to hear her lecture now. Instead,...

I received a response from WFOT regarding an email I sent them about a banner ad on their website. Here is their response: From: World Federation of Occupational Therapists [mailto:admin@wfot.org.au] Sent: 03 May 2008 17:25 To: 'chris@abctherapeutics.com' Cc: Marilyn Pattison Subject: WFOT: For Info: banner ads on WFOT website Dear Dr. Alterio Many thanks for your letter and the concerns you raise. I would like to draw to your attention to the following statement on the WFOT website: Placement of advertising either on the WFOT website or in the Bulletin does not imply any endorsement of the advertised products and / or services by the World Federation of Occupational Therapists. Based on this I would suggest your criticism of WFOT is somewhat unjustified and your disappointment misplaced. WFOT is staffed by volunteers and the organisation depends upon donations, individual membership and revenue from products and advertising to fund its international activities. The placement o...

Below is a feed I picked off of ScienceDaily - reporting on a study that was presented at the recent AOTA conference. I wish that more information was available - and I was unable to attend conference this year. I'll have to reserve most of my comments because I just need more information. I am encouraged by the apparent rigor of a double blind design - but wondering if they just used the Sensory Profile as a pre-post measurement. I'll try to find out and post more... Here is the newsfeed: Autistic Mannerisms Reduced By Sensory Treatment ScienceDaily (2008-04-27) -- Children with autistic spectrum disorders who underwent sensory integration therapy exhibited fewer autistic mannerisms compared to children who received standard treatments. Such mannerisms, including repetitive hand movements or actions, making noises, jumping or having highly restricted interests, often interfere with paying attention and learning. ... ; read full article

In the past I have blogged about evidence based practice so I don't really feel the need to revisit the topic at length. The use of evidence is not a passing fad but rather represents a real shift in the sophistication of our science. This shift was not just restricted to occupational therapy but occupational therapy was caught up in it. That was a good thing. I am revisiting this tonight because I was visiting the WFOT website and I saw one of their banner ads. The ad was for Schoodles , and the ad said "Changing the way therapists around the world assess children." Kudos to the advertising people at Schoodles because I almost never click on banner ads but I never heard of this assessment tool and was intrigued by the claim. Perhaps the Schoodles people will be sorry that I clicked because I don't really have anything flattering to say about their statements or philosophy. This Schoodles product is antithetical to evidence based practice. Although I understand and ...

File this under 'required reading.' Please head over to myphysicaltherapyspace.com, specifically to the entry on evidence-based practice and myofascial release interventions. This is an excellent discussion and I hope you all have the chance to take a look at it. Myofascial release is a modality that is much more widely used in physical therapy than occupational therapy, but it still crops up in OT interventions from time to time. I am especially concerned about so-called craniosacral therapies and the ways that some therapists combine these dubious interventions with other OT quackery. I really don't have more to add than what was posted by Jason Silvernail, DPT - so please go read his excellent entries!

I recently got this email question, again. It is a relatively common email that I receive so I thought I would post the question and my stock answer here... The Question: My school district/teacher keeps telling me that my child has ADHD and needs to be medicated. They have been harassing me at every IEP meeting and want me to medicate my child. I have absolutely refused because I never believed that medication would fix the problems my child has. How do I know if my child even has ADHD, and what should I do about it? How do I get the school to stop harrassing me? Any advice would be greatly appreciated. The Answer: The school district is not qualified or licensed to make medication recommendations for your child. Medication suggestions should come from your pediatrician/other physician, or psychologist who is working in concert with the physician. The point here is that medication is a medical recommendation and not an educational recommendation. Only people who are medically qualifie...

I am currently stuck in Chicago, and have been for the last several hours. To an action-oriented person like myself free hours feel like they are taffy-time - stretched beyond any point of recognition of what they originally were. This means that I have uninterrupted opportunity to mentally operationalise some plans. Mental operationalisation is somewhat oxymoronic, and I will need to explain that at another time. Also, I don't mean to use spelling that would more likely be found in other countries but a certain letter on this laptop is not working (the letter after 'y') and so I can't spell things in the way I normally would. Anyway, I spent some time thinking about occupational therapy 2.0, which of course is stolen from the web 2.0 lingo which I actually kind of think is funny. Again, a story for another time. Anyway, it is time for occupational therapy 2.0. The blog was the first foray for me into the 2.0 world, and I have talked about the power of social netw...

Here is a quick clinical scenario, in case anyone is out there glamorizing pediatric occupational therapy practice. This one is more "dirt road" reality as opposed to "street" reality. I have been in squatter's homes before that have amounted to little more than foundation-less sheds and shacks tucked away on corners of land that other people have abandoned or forgotten. These are sad stories, but they are realities nonetheless, and these people make up a certain underclass of society that require a lot of support. As I drove up a country road toward my destination I saw rows of dilapidated trailer homes with lots of bare plywood, litter-strewn 'yards', and many roaming cats. There must be good hunting for the kitties around here. The saddest part, I considered, is that this is an organized trailer park. Someone is actually charging these people for the electric and water hookups. I wondered what kind of person would want to make a business of supplying ...

OK that last entry was too philosophical so I needed to find something to counterbalance the point I was trying to make. I wrote this seven years ago and it will serve the purpose of illustration. Again, the concept here is that there needs to be some way to approach the meanings and intentions behind parenting decisions, and to find ways to harness phenomenological analysis as a tool to help parents move from point A to point B. Anyway, this is a personal example of how it applies - and I hope this will demonstrate the depth of meaning behind a parenting moment. Knowing this depth from a personal perspective actually intimidates me - how can we achieve this knowledge of parents whose children we evaluate? _____________________________ "The sun dipped slowly behind the last dying hill as I travelled westerly toward home. I used to look at the landscape when I first arrived here and bemoaned the lack of geographic relief - I was so accustomed to the lazy rolling of worn-down Adiron...

I know that I am a pediatric occupational therapist, but I am also an adult occupational therapist because all the kids come attached with parents. Often, the primary point of intervention is with the parent and I think the roadblocks that I run into make me spend a lot of mental time considering the problems that adults have in operationalizing their occupational roles. Now I know that I just dared to utter the term 'occupational roles' which I believe is probably not theoretically in vogue, but the concepts are still quite useful at times. That is a discussion for another time, I suppose. Anyway, I am currently stuck on Rowles again and the concept of 'being in place' particularly as it relates to parent's abilities to find themselves and function within some constricted occupational niche of parenting. So of course this problem in helping parents brings me to the core of meanings, values, and intentionalities that underly adaptive parenting behaviors. This of cou...