ABC Therapeutics Occupational Therapy Weblog

The issues are just too fast and furious lately - but this one had me falling out of my chair. Check out Collins comments on the burden of unfunded mandates from the State in this Buffalo News article. Collins statement as it relates to preschool services is excruciatingly correct - although I am not sure if his solution really solves the problem. The article states: "Besides Medicaid — the local costs for which eat up all the $200 million in revenues raised by property taxes in Erie County— Collins cited as among the unfair mandates a program that provides special services for children younger than 5 who need help to get ready for going to school. He said the county pays the costs of the program — $23 million a year — but has no authority in running a program administered by local school districts. When children turn 5 and schools have to then pick up the costs, Collins said, pupils are “miraculously cured” and no longer offered the services." This is oh so true, but the pre...

I received an excellent response from Jeff Tomlinson about the recent continuing competency issues. I didn't want his response to get lost in comments, so I am posting it as an entry. There is a lot of good information here. I would really like to hear more about the direct access issue and problems in securing scripts for school aged children - sounds like something that could benefit from roundtable conversation. Anyway, here is Jeff's response: I have also been encouraged by another occupational therapist to check out this discussion. We were certainly surprised by the speed with which the physical therapists were able to pass their mandatory continuing education bill. It was quite an accomplishment in a legislative session that passed very few bills that regulated the professions. I will be talking to the lobbyist and the leadership at NYPTA about how they got this done. At the same time, it should also be noted that the PTs continuing education law is not like the NYSOT...

Juliet: "What's in a name? That which we call a rose By any other name would smell as sweet." There is a history of name changes in describing sensory integration problems. People have probably heard: SI disorder SID (sensory integration dysfunction) DSI (Disorder of sensory integration) SPD (Sensory processing disorder) You can check here for someone's blog entry on the issue. The SPD Foundation (formerly KID Foundation) has mostly scrubbed references on its website to the words that are no longer in vogue. That is helpful, particularly since they are seeking DSM-V recognition of SID/DSI/SPD. Have I used enough initialisms and acronyms in this entry yet? Now we have a companion problem in that there are multiple meanings for the concept of a 'sensory profile.' I was googling some information on the Sensory Profile assessment and I came across these references: Sensory profile of mandarin chilled juices and consumers' acceptability Mexican Mennonite-s...

I don't know that I have ever seen any occupational therapy literature on idiopathic toe walking. For an excellent overview and references on this condition please check this article from the Journal of Family Practice. As the reference states, it is important to avoid 'over medicalizing' the problem especially since there are not many toe-walking adults that are presenting themselves for intervention. It is possible that toe walking is a self limiting problem in many children. However, there is a reasonable concern when toe walking begins to contribute to pes cavus deformities which of course can have longer term implications. In our clinic we see a few children each year with toe walking that is beginning to cause functional foot deformity. Idiopathic toe walking is a relatively common condition that is often seen by occupational therapists - but not generally as a primary reason for referral. Some professionals view toe walking as a marker of other developmental imma...

We are making strides in promoting continuing competence and ongoing professional development in the occupational therapy profession but there is still work to be done. The current theme running through my head has to do with quacksalvers and quality in continuing education offerings. As far as I can tell, there are few if any standards for the quality in continuing education courses as it relates to the CONTENT of the offering. I read the IACET standards and was disappointed that Standard 7 didn't really delve deeply into the issue of regulation of the QUALITY and CONTENT of continuing education courses. So if the primary standard-setter of quality in continuing education does not address quality of CONTENT, what should be done? As an aside, I don't know that I blame IACET - how could they possibly address quality across so many diverse topic areas? Does this leave the professional associations to make statements about quality of content? Or is this left to certification...

I recently posted on the status of continuing competency requirements for occupational therapists in NY State . In summary, my concern is that the bill for these requirements has been stalled in senate committees but a very similar requirement for physical therapists just passed. I wrote to NYSOTA asking about an update on this issue and have not received any response. Of course this is an issue that I have all kinds of historical interest in - and it is no secret to anyone that I am a long-term volunteer for the National Board for Certification in Occupational Therapy. This is where my passion over the issues of competence and competency was born and bred. Still, my feelings on this matter also have a lot to do with the perceived legitimacy of occupational therapy as a profession and broad protection of the public. Regulation is sometimes unnecessary and stifling - I am not a believer in the nanny-state. However, health professions are historically unable to police themselves app...

There is more opportunity to follow the conversation in the Advance for Occupational Therapy magazine about early intervention service delivery. I read the magazine today and still felt uncomfortable as I kept stumbling over what Dr. Jane Sorenson wrote: “At the end of the year, all of them were performing at maximum potential… I explained, as I do with all parents whose permanently disabled child is performing at his maximum potential within the reality of the disability, that more treatment won't mean more function right now… I believe it is our responsibility to the children to discharge them from direct service when they have reached realistic goals within the reality of their diagnoses.” I wanted to do some self-checking to be sure that I wasn’t applying any bias to reading her based on my disappointment over her previous comments. After a lot of consideration, I think I understand the nature of my concern and discomfort. It is the words. As an amateur anthropologist I hav...

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