ABC Therapeutics Occupational Therapy Weblog

I have had a recurring question in my mind since the beginning of my occupational therapy career. At that time I was working in an urban acute care psychiatric facility and I was fresh out of college with my head full of lofty ideas about occupational behavior, occupational role, and the potential of occupational therapy to solve societal problems. I read every word that Mary Reilly ever wrote, and listened as they were explained to me in the classroom by proxy of Phil Shannon and watched in amazement as they were practiced in a hospice home care setting while being mentored by Kent Tigges. Still, after work each day I took the Metro North to the safety of suburban living and I kept rolling over the question: "How can I remember NOT to transpose my values and my concept of Quality when working as an occupational therapist??" My training told me that I wanted my patients to develop options, decision-making, problem solving, and agency relating to some return to occupati...

Why would a CSE chairperson who has worked in the field for over 20 years suddenly want more information on the Beery VMI?? This chairperson has seen this assessment used hundreds of other times... so why more information now?? Inquiring therapists want to know. re: Johnny XXX To Whom it May Concern: At the request of the district CSE Chairperson, here is additional information regarding Johnny's performance on the Beery VMI. Quite honestly this is an unusual request as this test is perhaps the most commonly used assessment in school-based occupational therapy and I do not understand why special explanations are required for this child. I am hopeful that this information will help to get an appropriate plan for this child into place. The Beery Developmental Test of Visual Motor Integration 5th Edition is a widely respected assessment tool that is backed by decades of research and clinical use. The Beery VMI screens for visual-motor deficits that can lead to learning, neuropsyc...

There are many conversations swirling about regarding health care reform, proposed 'public options,' and tax/penalty methodology to pay for the programs. The more that gets said the less specificity seems to be revealed. Instead I am hearing a lot of lofty and non-specific theory that the system will pay for itself by 'inherent efficiencies' which I have concern may be code for rationing. When pressed for these kinds of details all I am hearing is a full-frontal assault on 'insurance companies' but occasionally there is a jab slipped in at providers who are accused of making decisions based on reimbursement structure and not on clinical necessity. There is no doubt that a reimbursement system obviously creates incentives and disincentives to how care is delivered - but to accuse providers of driving decisions solely on financial incentive is a little much. The added insult is to trumpet the 'endorsement' of prominent organizations - like the AMA - w...

Proposed new health care regulations may have an extraordinarily negative impact on the way consumers access their health care. The following information is from a September 2005 report from the Small Business Association entitled The Impact of Regulatory Costs on Small Firms. "The annual cost of federal regulations in the United States increased to more than $1.1 trillion in 2004. Had every household received a bill for an equal share, each would have owed $10,172, an amount that exceeds what the average American household spent on health care in 2004 (slightly under $9,000). While all citizens and businesses of course pay some portion of these costs, the distribution of the burden of regulations is quite uneven. The portion of regulatory costs that falls initially on businesses was $5,633 per employee in 2004, a 4.1 percent cost increase since 2000 after adjusting for inflation. Small businesses, defined as firms employing fewer than 20 employees, bear the largest burden of fed...

I was pleased to see the article in the recent OT Practice entitled "School Buses + Safety Belts = Good Idea." (Loveland, 2009). I think it is important for OTs to have a good discussion about ways to promote safety and prevention of child injuries. There are some additional facts to consider so I wanted to list them here: 1. In the studies cited in the Loveland article, there was an annual average of 17,000 children seen for emergency treatment for school-bus related injuries. However, that number is a little misleading. The study reports that only 42% of those injuries were crash related, so by extrapolation, it is arguable that seat belts would not have made a difference in many of those injuries. In fact, the 17,000 number includes slips and falls outside of the bus, getting on/off the bus, etc (McGeehan, 2006). 2. The National Highway Traffic Safety Administration (NHTSA) reports detailed research on their website about school-transportation related injuries and deat...

Here is the offending/offensive article: All-Night Care for Dementia’s Restless Minds I will be the first one to admit that it gets a little boring to listen to people have complaints about political correctness and terminology - everyone is offended by everything these days... but this article went so far beyond any semblance of acceptability that it has to be pointed out. I am not criticizing the program - because I have no direct knowledge of what actually happens there. In concept I think that offering night time respite care for caregivers is a great idea. Unfortunately, the authors of this article portrayed the program in a very negative way - and I don't think that they really intended to do so. Throughout the article the authors repetitively compare elderly program participants to children. For example: 1. The participants were "chattering and giggling like children sneaking out of camp." 2. A caregiver reports relief by stating, "It was like when your bab...

Or perhaps more appropriately titled: Too much information. Oh well. I wrote a blog entry once about 'the things I do.' It has been lost to time - I am not sure where I have the entry stored but I recall that it received many comments and sparked a lot of conversations about the issues of time and time spent - and how one comes to the decisions about the things they do. That entry is decidedly more serious than this one. So, I am not trying to recreate the original - but couldn't think of a more appropriate title for this entry. Maybe I will look for the original sometime. Today is a hard work day. I am not questioning why I am an occupational therapist but sometimes when I have hard work days I reflect back on what I thought I wanted to do when I grew up. I took a Strong-Campbell Interest Inventory in high school, and it said that my career interests were matched to a speech therapist, a college professor, and an actor. The fourth match was 'occupation...

Usually sometime around April I stop looking at the calendar because I no longer have time to look at calendars. Life in April and May is generally spent running from one responsibility to the next, non-stop. Then something strange tends to happen at the end of May, and I begin to realize that Spring is in full bloom and that there is indeed a light at the end of the tunnel that all pediatric therapists are running through this time of year. Here are some common experience-markers that are making me believe I will soon have a life again... 10. The semester is over for most college students - and my son completed his undergraduate career! 9. Robins have nested in all of their favorite spots around our building and the baby bird chirping is louder each day! 8. Memorial Day Weekend! 7. Pediatric OTs are beginning to look for jobs! (the better ones always finish out the school year first). 6. My landscaping contractor has repaired the lawn damage from winter plowing and has cut the gra...

Standardized tests are periodically discarded or updated because the normative group that the test was developed around may have changed characteristics. I am unaware of any 'industry standards' regarding the life expectancy of standardized tests; rather, professionals in a field tend to come to consensus about the relative usefulness of tests on their own. I would be interested in knowing what other therapists think about the Sensory Integration and Praxis Tests - which were published in 1989. I became certified in the administration of these tests seventeen years ago. At first I found them highly useful but the more I gave the tests the more I understood the limitations. Now it has gotten to a point where I do my best to discourage people when they ask for this test - not just because of the inherent weaknesses of the test construction but also because of how old the norms are. There have been some legitimate concerns with the tests including extremely poor test-retest re...

In 11th grade I took a computer programming class - computers were brand new technology at the time and the teacher knew little more than the students so it was definitely a wide open frontier. The computer was an excellent tool in that programming forced my adolescent brain into a type of linear and logical thinking pattern that I still find useful today. The teacher often had us work in pairs on larger projects and I had an excellent programming partner. We regularly challenged ourselves with writing complex programs and we were sometimes over-ambitious. One particularly complex program we attempted was to write a 'Blackjack" program. I remember how excited we were when we got the cards to print correctly on the screen. This was high-end stuff for a couple of high school kids hacking away on a TRS-80 Model III computer! Our Blackjack program became increasingly complex, and as we attempted to make accommodation for ever increasing complexities the programming code becam...

Is this about saving money on facilities with empty beds? Or is it the confused problem solving coming from politicians who have empty heads? In a Rochester, NY Town Hall Meeting on March 11th, Governor Paterson was asked about his plans for adults who have developmental disabilities who are on long waiting lists for residential programs. Currently, many are living with their families because NY State lacks housing options for this population. Politicians should know that this is not a new problem - New York has a long and storied history of problems in providing residential services to people who have developmental disabilities. I blogged about the history of the Willowbrook State School several years ago; I encourage you to click this link for a background study of the situation http://abctherapeutics.blogspot.com/2005/11/new-yorks-disgrace-30-years-later.html Certainly options are different since Willowbrook was closed. Residential treatment programs in the years following 1987...

Mrs. Kim was one of my first patients when I was a young occupational therapist. She was an 89 year old resident of the nursing home and lived there for the previous seven years. Prior to her admission she was living at home with the support of her only son. She had diagnoses including hypertension, chronic obstructive pulmonary disease, and Alzheimer's disease. She had a history of depression and severe anxiety. Mrs. Kim was a known 'flight risk' and tried to leave the nursing home facility on several occasions. The nursing home responded appropriately by installing window limiters and door alarms. Out of an abundance of caution they also made sure that Mrs. Kim always had her identification bracelet and she had an alarm that would sound whenever she wandered outside of a designated perimeter around the nursing station. Despite all of these precautions she still managed to find her way out of the facility on at least three occasions in the preceding seven years - w...

I very rarely step into politics in blog format because of the inherent landmines that one encounters. People hold tremendously polarized worldviews that make coherent debate difficult - but sometimes an issue stands out in a way that makes NOT commenting wrong. President Obama went on Jay Leno's show last night. I am not a huge fan of television so I rarely watch these shows. Still, I knew that I wanted to see 'what he said' when I checked the news this morning. Apparently, in reference to his own poor bowling skills he made what is now being spun as a 'self deprecating comment.' Obama's comment about his bowling skills was "It's like -- it was like Special Olympics, or something." In presumably light hearted banter he also allowed himself to be drawn into comments about "water-heads." This is an unbelievable lack of dignity from a President. The political spinmeisters who think that deflecting the comment as a statement about Obama...

There was a time when people paid their MD with chickens or apple pie. It was a bartering economy that made sense between the participants. For many years doctors resisted governmental efforts for universal health care and insurance companies did not want any part of trying to develop risk models that would make health insurance a money-making product. Houses were easy to make insurance models for - but no one wanted to deal with the vast complication of risk assessment for human health. Lots of things happened throughout the 1920s and 1930s that pushed insurance companies into the health insurance market: the Flexner report called for and prompted improved standards in medical education, small union groups began negotiating fixed-cost hospital coverage plans, and demand for medical services increased as medical technology improved and large populations of people moved from rural to urban centers. Health insurance grew through the 1960s and then government entitlement programs were e...

Three years ago Nixzmary Brown's murder had everyone talking about child abuse and how 'the system' fails. There was no shortage of commentary about how broken the child protective system was - after all, child protection workers were already involved in the case and stated that claims of abuse were 'unfounded.' Tragically, it took a child's death to provide enough substantiated evidence - and even then the so-called parents were only found guilty of manslaughter. Suspected abuse that is reported to child protection workers is often 'unfounded' - you can find a few such cases that I have ranted about in these blog pages. Once I reported cigarette burns on a child's legs that were determined to be 'unfounded.' Another time cigarette burns on a different child's arms were 'unfounded.' In another case I had, a caretaker was cramming food down a child's throat who could only eat via g-tube but that wasn't a problem . ...

I need to turn Thoreau on his head a little here - I made mention of 'desperate parents' in a blog note last week and on cue I had a discussion with a mom recently and she looked me squarely in the eye and said You do realize that you are talking to a desperate parent, don't you? Of course I knew that. It is the time of year for reviewing Individualized Education Plans. This particular mom's story was not so different from the hundreds who have preceded her. She wanted to know if she was crazy, or if she had odd expectations of her school system, and why she was having such a difficult time interacting with her child's educational team. I began my private practice with the naive notion that I would function as a private therapist for approximately 2-3 years, work with families and school districts to help them bridge gaps of misunderstanding, and likely put myself out of business after engaging in several years worth of advocacy and educational efforts. That wa...

I am working with a student who is completing a literature review on the concept of fidelity in sensory integration. At the same time I am completing a book chapter on entrepreneurship and today came to an interesting perspective on the state of sensory integration theory and practice models. Reality dictates that people purchase goods and products and will pay for them based on some value formula. Occupational therapists have famously made references to the value of their services - from Mary Reilly's belief that OT could be one of the great ideas of 20th century medicine to the more recent AOTA branding campaign on how OT helps people live life to its fullest. If both of these statements were true people would be flocking to seek out and pay for our services. Is this the case? Certainly people are receiving occupational therapy services. Certainly insurance companies and others are paying for occupational therapy services. Despite these facts, it is true that the ...

Occupational therapy, at its best, is a change-enabling service that helps people accomplish goals that are personally meaningful and relevant to how they occupy their time. For kids in school, this means being able to learn and socialize and develop skills for future citizenship. Therapists routinely wring their hands over issues of eligibility criteria for said services and balance this out against spoken and unspoken procedural rules that are generally applicable only within their own school systems. The interesting aspect to this is that any given school based OT will then believe that the way THEIR school district operates must represent the way that ALL school districts operate (and for that matter, how they are SUPPOSED to operate). Those of us who have the opportunity to interact with dozens or scores of districts across wide geographic areas have wider exposure to the variety of ways that districts interpret presumably identical criteria and rules. Twice this year I have th...

Convolutions have always been interesting to me - and that is the way that I have always tried to understand the complexities between itch and scratch. I think I slept through any references to Fourier analysis that I was ever exposed to though so I am kind of weak on applying a mathematical model to the problem - even though I think that is the best way to consider the relationship. This is why I am an occupational therapist and tend to keep myself in application/behavioral analysis - because as soon as I dunk my head into the literature of molecular pain I start to get a little lost. I find some solace in the knowledge that even the molecular pain people are still figuring it out though. Itch and pain are oddly connected. Histaminergic systems seem to be square mediators between these two sensations. In conversations with OTs I have heard people talk about local histamine release associated with brushing - but this always seemed (to me) like it was an overly simplistic way to exp...

The context for this entry is that there has been some debating lately about what constitutes occupational therapy and if it can be represented by symbols or even words. So file this entry under: "An example of when the story probably works a little better than the image." Caleb is thirteen years old and he lives in a shack on the east side of the city. His father abandoned the family long ago and his mother has been on disability payments for as long as she can remember. It's a little difficult understanding the full story because all of her teeth are missing and her articulation isn't particularly clear. That could be part of the reason why Caleb has speech delays - because the voice that he has heard since infancy, although loving, is like listening to marbles rolling over white noise. Caleb has a moderate degree of mental retardation for which there is no specific cause. It could be genetics and it could be environmental but it is likely both. He relies on...