ABC Therapeutics Occupational Therapy Weblog

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 bec...

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 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...

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...

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. ...

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 function...

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 fac...

Corporate practice and the health care professions in New York State might not be on the top of everyone's interest list but there are some things that professionals and the public need to be aware of.  In New York State and in many other states for that matter there are restrictions on who can hire professionals to provide services.  These kinds of laws prohibit any random person from starting a corporation and hiring OTs or PTs or any professional and billing for those services.  The reason why those laws exist are because people think that there is potential for abuse/fraud/unethical choices when professionals are not 'owned' and 'supervised' by people within their own professions. Now of course just because an OT hires and OT or a PT hires a PT that does not guarantee that unethical things won't happen.  Still, there is generic concern so these laws were enacted to prevent abuse.  So, in order for PTs and OTs to both be hired by a corporation there needs...

More for the file 'whose kung fu intervention for autism is strongest.' Lang, et.al. (2012) published a systematic review of sensory integration therapy for autism spectrum disorders that at the same time has academically dishonest and potentially useful information. The review errs in its rather lopsided inclusion of articles that measure the effects of isolated intervention strategies that would probably best be identified as addressing components of sensory processing as opposed to measuring a sensory integration methodology.  This is nothing new; there have been some good articles in the American Journal of Occupational Therapy recently that have contributed to debunking the use of seat cushions to promote attending behaviors and debunking the use of weighted vests to promote attending behaviors.   These findings are yet to filter into practice because a lot of people really like the idea of quick and easy answers to complex problems.  Finally we are getting to a...

There was an interesting conversation on the AOTA forums recently about whether or not a COTA should be 'bathing' patients in a nursing home. Some of the conversation centered around the 'skill set' of the COTA and whether or not the COTA was being used in a nursing assistant type of role.  Then there was discussion about whether or not this was appropriate, and some people thought it might be appropriate as long as it wasn't being billed out as direct occupational therapy (unless there was some therapeutic self care training aspect to the task). Most of these points were valid - but as is typical in online forum posts there is a real lack of detailed information so it is almost always near impossible to know if any answer provided is really the best answer for what is being 'asked.' Something else jumped out at me though while I was reading the conversation.  Someone said, I say not bathe the patients because that is not what they went to school t...

What motivates a memo from your government? Today I was sent a memo from OPWDD that addresses the issue of interagency coordination between the Office for People with Developmental Disabilities (OPWDD) and the Early Intervention Program in NY State.  Why are they motivated to better coordinate services between governmental agencies?  Simple answer, if you read the news. Costs for special education services are soaring in New York , as documented in this NY Times article.  Quasi-privatization comes at some cost, which really can't be denied.  If you want to get depressed go and read some audits from the State Comptroller's office.   If you are less motivated to read these audits then just watch the news and you will see several articles like this every year.   In sum, there are bad eggs out there who are gaming the special education system at taxpayer expense. The problem with the Times article AND the problem with the resulting memo from OPWDD is t...

It was very early in the morning - so early that it was actually still nighttime.  Of course this is not an appropriate time for any rational person with a daytime schedule to be awake, but I couldn't sleep so it seemed that the most sensible thing to do would be to go food shopping.  Don't ask. Anyway, as I strolled up and down the aisles I was lost in thought regarding how decisions were made for product placement on shelves and whether or not the items I would be interested in would be at my eye level.  In my dreamy 2am somnambulatory state I felt an unexpected tap on my shoulder that caused me to whirl around suddenly to see who was interested in getting my attention. "Good evening, sir!" said the unfamiliar face of a 30 something year old young man.  The voice was not familiar either.  Then I squinted and tilted my head just enough to catapult me back to 1992 when I knew Aaron.  Amazingly, the haircut was the same and was the predominant feature th...

I was happy to see the American Academy of Pediatrics publish their new policy statement about sensory integration.   I know that a lot of people are up in arms about this policy but in my estimation the AAP presents a very fair and balanced assessment. Defenders of 'sensory processing disoder'  are quick to point out that some more recent research was not included in the AAP review.  I was disappointed when I read Dr. Miller's letter to the editor where she talked about the 2007 RCT.  This was a great study and I think they did an impressive job of looking at limitations in previous studies but it was only a pilot study and it lacked statistical power, there were noted blinding problems, and it relied on GAS which many people believe opens up issues of expectancy and confirmation bias. My point here is not to rip apart people's efforts because actually it was a good step forward in our research.  The problem is that we can't point to studies like th...

You can file this blog post under "Things you might not know unless someone tells you, so I am telling you." I am not an expert in pain by any means, but I learned a simple lesson once that I wanted to express.  It is so simple to remember and I am disappointed that I learned it a little too late. Anyway, for a real expert on pain I refer you to Bronnie Thompson's blog at http://healthskills.wordpress.com/   Her blog is my final destination when I want to learn more about pain issues. On to when I learned my first real lesson about pain. Today I was reading an interesting article about the Numerical Rating Scale that you can find here .  The scale is imperfect, and it really doesn't work for children all the time.  For kids we use things like the Faces scale that seems easier for them to understand.  Still, degree of pain is an elusive thing to measure in kids - and Lacey taught me that better than anyone.  I remembered her today when I read ...

New York State has an electronic information management system for the Early Intervention Program that involves a mechanism for billing and reporting services to the municipalities and state.  This system is called the New York Early Intervention System and is generally referred to as NYEIS.  I received email today regarding use of procedure codes in the NYEIS system and I want other practitioners to be aware of some issues. The email describes the difference between Level I and Level II HCPCS codes.  In quick summary, Level I codes are also referred to as CPT codes and are standard and typically accepted codes that represent the professional activities of licensed health care professionals.  Some of them are rather specific and include things like "OCCUPATIONAL THERAPY EVALUATION" or "PHYSICAL THERAPY EVALUATION" or "THERAPEUTIC EXERCISE."  Some insurance companies don't approve of some of these codes, particularly if they think that there is not ...

I was invited to speak at a PTE induction ceremony.  Here is the text of my speech.  Please excuse the vernacular and form; it was written for oral delivery: __________________________________________________ Hi everyone and thank you for inviting me to speak to this group.  It is an honor to be invited and I want to congratulate all of the students for their excellent efforts and performance, I want to congratulate the parents and family members for all that they did to lay the foundation that made this excellence possible, and I want to congratulate the faculty for all of their contributions that also helped with the achievements we are here  to celebrate. Pi Theta Epsilon was not in national existence when I went to occupational therapy school, and I am so pleased to see how it has grown and flourished in the last 25 years.  Students frequently ask me "Is is worthwhile to participate in things like PTE?"  I always answer with a heartfelt YES!!!....

This weekend I participated in a presentation with four OT colleagues at the AOTA National Conference in Indianapolis.  Conference can be a little stodgy at times- but not with this group! I want to publicly acknowledge the OT Social Media Awesomeness of this group of people who obviously know how to have fun and be awesome/inspirational/educational at the same time: Cheryl Morris: http://otnotes.blogspot.com When I saw Cheryl's level of extreme organization and skill in managing multiple information sources and easily coordinating a cascade of incoming information I was just amazed.  Then I wanted to hire her to help me organize my office!  She was the glue of the group and did a fantastic job getting it all initially coordinated. Anita Hamilton: http://technots.blogspot.com OK, so when I met Anita she was in her pajamas, effectively modeling the garb that could be used to conduct a groundbreaking and worldwide online occupational therapy conference (www.ot4ot....

There was an open forum at the AOTA conference in Indianapolis so I took the opportunity to raise a question about the profession's advocacy regarding research on sensory integration. My comments were: I appreciate the advocacy offered by AOTA regarding the situation in North Dakota where a coordinated letter writing campaign contributed to a BCBS intermediary indefinitely holding a decision that would label sensory integration as 'investigational.' However, it is true that Cigna, Aetna, United Healthcare, and nearly every other BCBS intermediary labels sensory integration as an investigational intervention. Additionally, the National Autism Standards Project and the NY State Clinical Practice Guidelines for Early Intervention also labeled sensory integration as investigational. With so much of the larger world identifying something as investigational, is it possible that AOTA places its members in an awkward position by continuing its advocacy without a more tempered a...

I just saw a flyer from a local advocacy and educational center about a seminar they are offering for parents about the transition process between CPSE and CSE. This is a very good group and they provide valuable services to parents, but I was wondering if they would describe the transition process in terms of how it SHOULD be or how it ACTUALLY IS. Here is a review of how it ACTUALLY IS for many parents who are unlucky enough to live in certain school districts. In February a school asks all the related services people providing OT, PT, Speech, etc. to give their opinions on whether or not a preschool child should be considered for CSE referral. The school compiles these generic opinions and based on some unknown decision making process sends some of the names over to the CSE for consideration. Then a giant wall is erected and there is never any additional communication between the CPSE and CSE. Sometime in March or April I get requests from CSEs to participate in these meetings, ...