Writing Sensory Goals

I often get visitors to the blog looking for goal writing tips. A recent commenter asked about writing sensory related goals. While this is not something I am an expert in, here is my approach.

I think that sensory based goals can be difficult to write because we have to know exactly what we want to measure, and we know we have to be specific and objective so that we can measure the effects of our interventions. We know when someone increases their ROM or strength and have portable tools to measure that, we have standard measures of ADL performance. As of yet, there aren't widely used, scientifically based tests or tools to measure sensory processing that we can just stick in our bag for re/assessment. (yes, some people do astronaut training or interactive metronome or whatever else, but I don't think that there's an item that meets those qualifications) So since most of us are not equipped to measure sensory responses through advanced measurement of vital signs and neural responses, we have to make our objective something else, something with functional relevance.

Some sample objectives that you may be trying to improve with sensory strategies might be to increase tolerance for a non-preferred activity (seat work, being in a store, novel food), decrease outbursts or other undesirable actions, or demonstrate an ability to self regulate (identifying personal alertness level, self selecting appropriate sensory breaks). A frustrating thing is not just trying to be specific enough in this objective that you have something relevant to measure, but also accepting the fact that none of these activities exist in isolation, so there is no direct correlation for cause and effect. You can do all the "right" interventions and the goal can still be unmet.

We're still going to use a SMART or RUMBA format for the overall goal. The following were my original sensory goals (rescued by the wayback machine), and you can see that they don't fit those formats.

-pt. will tolerate 1 "unpleasant" stimulus per session
-pt. to attend to seated activity for 10 minutes following sensory activity
-family to report better sensory seeking behaviors at home

These are are not very specific, and they don't really show what the performance component to be addressed is or what the OT method for improving this deficit will be. Remember that people are seeking (and paying) you for the Assessment and Plan section of your eval & notes, so it is important to be clear.

When I was writing those goals, I asked a friend who had been in peds longer than me how she did it. Her responses are as follows:

- Patient will demonstrate decreased tactile defensiveness by tolerating hair brushing and face washing without adverse reactions with minimal verbal cues.
- Patient will demonstrate improved modulation of the tactile system by accepting 3 bites of one new food in 4 weeks with minimal verbal cues.
- Patient will demonstrate decreased auditory defensiveness by decreasing ear covering by 50% independently.
- Patient will demonstrate improved sensory modulation by self calming with the use of sensory techniques as needed 100% of time.
- Patient will demonstrate improved modulation of the oral sensory system by mouthing one or less inappropriate objects during a treatment session without verbal cuing.
- Patient will demonstrate improved modulation of the vestibular system by decreasing spinning by 50% without verbal cuing.

You can see that these aren't all completely terrific either, but there is a great improvement over the others. We see the specific sensory area that was identified as problematic, the specific reason to the family that it needs to be addressed, and if we wanted to improve these farther we could give a success rate to know whether the goal is met (4/5 trials, etc). (Know that no one is going to self-calm 100% of the time, no matter how good your intervention is.) I like the specificity of these goals because it leaves less to chance that the success is from something other than OT intervention. With mine above, a kid might tolerate an unpleasant stimulus for many other reasons than the implied OT intervention. So being clear on what is to be achieved and with what frequency is important.

New blogger welcome

I don't usually throw out welcomes to new blogs, since I either find them late or post too late to comment on their arrival, and there seems to be a high dropout rate in blogging as well. But I saw posts from a new OT blogger and put it on my RSS immediately, so I want to share.

"Embrace Your Chaos" is a name to be envious over, and this blogger seems to be on her game. Her post about turning 30 struck a chord with me as it reflects a lot of feelings I am going through as well. So welcome to OT blogger world! (we should have a facebook page, haha)

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Phebruary Photo Phriday!

I hope people aren't sick of this pheature, since it allows me to express my punny self and do shorter updates when pressed for time.

I love this little activity I found in our toy closet which has either missing picture parts or a hemi picture like this. This the third or fourth attempt with my little buddy who obviously has some serious perception problems.

This job has made me totally paranoid about my grip. But look at Tina Fey's (or her stand in?) grip! Proof you can be an awesome, famous writer with a thumb cross grip.

I would think that cursive l & e would be the easiest, but it's still quite difficult for a lot of my friends. You can see the one I turned into Dory, if you have super vision and a warped sense of art. I got a bunch of these whiteboards at Target for $1, which was a real winner in my book.

I originally started this blog to share my literal notes from OT school. This cabinet now holds most (but certainly not all) of my OT knowledge stuffs. Granted, there are a few aged items from book sales and some my mom's relevant stuff from her days in voc rehab, but that is a lot of stuff.

$10 at Dollar Tree provides a really kickin' prize box. The princess rings and squishy grips are my favorites.

Switch toy obstacle course? Yes, this is the best job ever.

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Update on Goals

I got a comment recently about writing sensory goals so I will work on that over the weekend. And hopefully work on a few big projects for April. But, tangentially related to this topic, I thought i would offer an update for accountability purposes on my Tangentially Job-Related Goals.

I had lots of actual job goals, things that I wanted to gain experience with and mastery over, but the following were just semi-related to work at all.

1) Learn to Navigate the County: I am doing much better with this. I had mastery over locations until I started covering 2 schedules at once and so now there are a bunch of odd driving combinations instead of just to school and back to office. I still rely on the gps but I was able to help my husband get to the mall from an odd location around town, so this is going well.

2) Find Awesome Eateries: This is not going so well. The vast majority of my eating out dollars are spent at Wendy's or Panera, with some random dollars dropped at Sheetz. I should have more time for lunch (read: more than 15 minutes) mid-March.

3) Improve Time Management/Job Separation: I think this has been going pretty well. While I continue to carry some stress home, it's not as bad as the hospital. And I have not carried any paperwork home with the exception of learning to alter an excel spreadsheet.

4) Dress Like an Adult: My go-to items are essentially fitted long sleeve t-shirts, but I think I still look like an adult. I have a couple of dusters that are getting a lot of wear in this uneven winter weather.

5) Find Time for Physical Activity: These results are somewhat disappointing. I was doing well with running. Then I irritated my IT band pretty badly (I went to a football game where I had to take stairs one at a time, for some perspective). I took time off to rest and prevent it from getting worse. I tried to ease back into running with a new, start from scratch plan (depressing in itself). After 3 weeks, I started getting that familiar pain again. I'm really frustrated by it since it's hard enough to get up and try something, let alone have injury to deal with. I have been doing some strengthening at home but I don't know that it's working. I haven't used my gym membership for months due to the winter doldrums and fatigue. Running is the easiest to do since I can do it at home and I was in a spot where it was a great stress buster. I really need the stress bust, so I hope something works out soon.

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HWT Webinar

I've enjoyed using the Handwriting Without Tears products this year at school. In case you aren't aware, they are offering a few free webinars that may be helpful to your practice. I have signed up to attend the Response to Intervention one since that is a concept I am still learning about and would like to see develop more in our district. It is being given by 2 OTs, and while it does not specifically say so, there's no reason that it shouldn't count for continuing education on some level, just check through your state guidelines when submitting. I like to pass on good CE resources, and especially those that are free and appear to have some thought put into them, since unfortunately "you get what you pay for" in many free courses. Hopefully this one will be well done, there's no reason it shouldn't be given the overall quality of the company, IMO. Continue reading

After a few wondrous days of ease in December, I made the transition to a new caseload. I say "made," but clearly I am still only "making" a transition.

Jumping up from pre-K to teaching cursive writing and higher level praxis skills has been fun, but definitely an adjustment. I would like to have a time machine to go back and tell Miss Wilson that I would someday be helping others learn cursive handwriting- she might faint from the shock! I used a dodgeball on Friday for praxis skills, teaching novel dribbling drills I haven't done since high school. I also reinforced that if you want to really impress a young child, you should give them a behind the back pass. Kids eat that up. :)

I had a kid who was having a bad day, really slumped in his desk and didn't want to come to therapy on his first day with me.
I introduced myself in the hallway, saying, "Hi (kiddo), my name is Miss Cheryl."
He repeated "Miss Cheryl?" and then followed with "I don't like that name."
I took a breath, and a page out of Karen's book, and said, "you can either call me Miss Cheryl or Miss Awesome, but we're going to therapy now."
Later in the session, after our fun time, he said, "I love you Miss Awesome."
:-D kids can be very fun.

I need an activity using calendars... my grandma gave me about a dozen calendars and I need to find something to do with them. I definitely am going to take a few to the schools where I have students very intent on having their normal therapist back so that they can mark down the days to her return. When I say, "she had a baby and needs to be at home for awhile" the answer is almost invariably, "she'll be back tomorrow?" (unless it's to ask me an inappropriate question about the baby process- talk about a nightmare!)

I'm really enjoying my school system job, and despite the meetings and scheduling snafus, it's really not overly stressful. The school schedule itself can be a little challenging, we have several Mondays off this week and a lot of time off in April as well that makes it hard to make up visits. My personal schedule will get more complicated soon with the legislative session starting up again and time drawing nearer for conference (109 days! eek!)
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Photo Phriday- creative style

I have always liked the idea if the SticKids program for making sensory plans and handouts, and now I actually get to use it! While I do have some issues with how the SticKids software works, I still think they make my job easier with the products I can create for students. Sometimes though, only your own picture will do. (this was an activity we had safety tested in the classroom)

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Photo Phriday: Mat Man

I love the Handwriting Without Tears products (fortunately my district has plenty) and the concept of Mat Man particularly. I think there is a huge advantage to be gained in spatial awareness, prewriting, and body awareness from teaching Mat Man. There's even a cute online game that even includes the song (requires a free login). I've used the manipulatives and drawing sheets for individuals and groups of preschoolers this fall.

Here's some photo results from kids who used the manipulatives or interactive game first and drew pictures onto frames second. I love the repetition to cement the ideas, and the progressively more empty drawing frames to chain the task.

This drawing is by a child with autism in a 3 year old classroom with just a few prompts for parts. She drew fingers independently. She so often refuses to attempt anything on paper or try anything herself but she loved doing her drawing on her own. I enjoyed the pig nose and muppet eyes, personally.

This one is by a little 4 year old with autism in a special education classroom. He had a couple of cues as well and could write his name on the back too.

This one is by a 5 year old in general education preschool. I only interfered after he drew the first hand. Undoubtedly, this Mat Man will be an excellent piano player.

This one may be my favorite, just because I know the child. He is a 4 year old with autism and severe behavioral issues in a special education class. He loved building the Mat Man and worked really hard to make it match the picture perfectly. And he drew this with only cues for ears. Granted, he has fingers without hands, but I think this is pretty stunning given that he previously would not copy a circle. It was so great to see him calm, happy, and attentive throughout the activity, and he was proud of his work.

I was really pleased with the reception that the Mat Man activity had with the kids, and also with the results. Not everyone had such terrific results, but all these are after one session only, and I think there is great face validity to the concept.

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Simulations of Learning Disabilities

It can be very difficult to understand what it's like for a child with a learning disability to participate in classroom activities, especially for a child who can't articulate all they are dealing with. I find it hard sometimes to plan treatments for kids to address some compensation methods or remediation of skills since I am still getting my feet wet. It's also hard to see preschoolers with simultaneous severe physical, visual, and communication impairments as they struggle to pick up on concepts such as identifying themselves, choosing an object, using a switch, etc. Some kids work EXTRA hard to learn, and if you were a good student and good at understanding the system (playing the game, as my Dad said) it's hard to see how something so easy for you can be so hard for someone else. So I encourage you to explore these sites' simulations a bit and try to work through the trials they have set up. Honestly, I could not make it through many of the sections. Just a short exercise to better understand struggling learners- appropriate for teenagers and older.

PBS Site for Misunderstood Minds. Thanks to Teaching Every Student for the link.

Children's Vision Network site for Vision and Reading

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So I finally got some pictures off my phone! Here are some OT-related pics that you may find amusing.

It's totally unnecessary for parents to tally scoresheets themselves, but that doesn't mean I don't appreciate it!

Can you tell this backpack belongs to a pediatric OT? This is an awesome dragon puppet that has a multitude of fasteners along his tail. Everyone loves Danny Dragon.

This is a shot of the beading dowel. The little guy who did this had no problem matching colors but was just randomly lucky on getting the right shape (30% or less, all trials. Pretty sure that was the only purple bead too).

This is a picture that the students made after reading "Dog's Colorful Day" where Dog encounters 1 different colored blob during each part of the adventure. Can you tell which child worked on her picture as part of an OT session? And also had a bit of a perseveration problem? lol

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Visual Motor Freebie

I found this I Spy sheet on Scribd which can be downloaded for free. Some of the images are a little odd, but whatever. I added a document on Google Docs (here) which has a list of the items in the sheet (notations about which ones look a little odd and might be hard to identify) and has a few searches listed out to better make it into an activity. There's a screen to check the 4 quadrants, a listing of animals, and a few common letters listed out.

Happy visual hunting!

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Moving into winter

I'm coming up on my third month of being a school therapist and a homeowner, and had a few other interesting things happen recently. Here's a bit of a recap.

I was feeling very over my head in the past 2 months about the conference presentations I had applied to do. I had my usual procrastination battles and feelings of not being qualified for one reason or another, really kinda getting down about it all. In summary, I was a lot more excited about presenting when I signed up in the spring than when it came time to present in the fall. But things turned around and I think they both went over well. I talked about some options when beginning a pediatric practice in a hospital based on my Baltimore experience getting mentored in the NICU, newborn nursery, pediatrics and antepartum units. I had a crowd of mostly students but there was some interest. I felt kinda old since there were a number of students from my alma mater and I knew none of them, though there was a "small world" I-know-who-you-know moment.

Wooo!

Ben, AKA OTA_Stolinski is the winner of the Dycem giveaway! Congratulations! I see a turtle mat in your future! Email me at otnotes at gmail. I will definitely consider doing more giveaways in the future, (should I have items to do that with) but hopefully there will be more legitimate comments and fewer advertisements for fake universities and/or job search engines. Continue reading

The Biggest OH NO Moment Yet

Worst moment yet of this job:

We have a high number of kids transitioning out of early intervention and into the IEP system. More than usual. So that has led to tons o' evals, IEPs, and meetings. I've been proud of staying ahead of all that needs done. Monday, I finished up all of the evals and the entirety of the IEPs. And today, at 330pm, I discover everything has been obliterated for 2 IEPs. Completely and utterly gone. And due on Monday.

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Tangentially Job-Related Goals

Clearly, with my job in a new field and situation I've never been in before, I have goals. I want to be competent (and if possible, awesome) at what I do. But since there are a whole host of other things going on, here are my goals that are only somewhat related to the job.

• Learn to Navigate the County: I have never been great at finding my way. GPS was essential in Baltimore since I would likely still be driving around North Street trying to get home. My husband does most of the driving when we're together, so I didn't get a lot of practice. Now we've bought a home in a larger-than-I-thought county and I want to know how to get everywhere. Today I went to the extreme East end, and I will regularly be covering points West and South as well. I want to know short cuts (or at least the basics). Ideally, I will be able to out-navigate my husband. We'll see.
• Find Awesome Eateries: I still pack my lunch a good bit, or hit the grocery store salad bar. But I want to find cool little unique small business eateries. I want to be a regular at the best dives in the nooks and crannies of town that can provide lunch in 30 minutes or less.
• Improve Time Management/Job Separation: A major problem at my last job was working extra hours and not being able to "turn off" at the end of the day. A prime factor in our decision to move from Baltimore was to have more family time and take up worthwhile activities during the down time. So this is a crucial personal well being step.
• Dress Like an Adult: I've worn solely scrubs to work for 4 years. This includes not just cute little outfits, but t-shirts, items scrounged from yard sales, and shirts from my Grammy's own collection. Most people would not consider this wardrobe very fashionable, or even always the right size. Now I wear nice pants and shirts... time to be a grown up and look professional! Also, I get to fix my hair nicely on occasion instead of keeping it pinned back constantly.
• Find Time for Physical Activity: It's never easy to fit in everything you want to do in a day. So I really want to focus on making time to be active. So far, I've been able to walk to the school closest to my house, and work in some school laps during lunches/breaks. On days that I am at a "campus" or several nearby schools, I hope to be able to walk or bike. Incorporating the activity at work is something I'd like to do, and it demands that I pack efficiently and prepare well for the day, so it's a lot to work on. Ideally, I will also do some things before or after work, but I'm still ironing that out.

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The more things change...

So I have been working tonight on an entry about the indecision I have right now about the future and the convoluted OT path I have taken up to now. At one point, it started to seem familiar. I felt as if I had quoted Thomas Merton before, and it turns out, I have, 3 years ago when I was equally wondering what the heck I was going to do with my life. Oh goodness... that's a sign it's time to stop thinking for a little while. :) Sudoku here I come! Continue reading

Don't forget- World OT Day!

October 27 is World OT Day! Sponsored by WFOT (now on Facebook), it's a great day to proudly raise awareness about the profession. I would rock my Super OT shirt, but I have formal meetings, so I'll wear inner-OT-awesomeness instead. :)

This is the sophomore year for the OT Virtual Exchange and they have once again put together a powerhouse group of speakers for a 24 hour time frame. There is a theme of "Pay It Forward," so you should enjoy the quality talks for free and then share your OT knowledge out in the world as well! Check out the schedule here, and be prepared to tweet using the tag #ot24vx.

Linda from the great blog Daily Living Skills is also running a blog carnival to celebrate! It's been way too long since we had an OT blog carnival, I'm excited to see the entries, and I hope we can keep the energy going.

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Our OT Identity

In celebration of World OT Day, we are discussing the Global Identity of Occupational Therapy. It's an interesting topic since there has been a lot of discussion about our national OT identity with the approaching Centennial. I think the best thing that I can share for this topic is my summary of two of the best AOTA sessions from the 2011 conference (and maybe from ever).


Last spring, there were two talks that best fit with the presidential address and stood out as completely awesome. One was "OT Survivor: Protecting Your Turf in a Competitive Healthcare Market" by Pam Toto and the other was "Practicing Authentic OT: Strategies for Becoming a Reflective and Reflexive Practitioner" by Debbie Amini. These ladies are both well recognized in the field. Energy was definitely palpable in both rooms, and I even got to meet (again) Suzanne Peloquin during one session. (If a Slagle lecturer shows up in your room- you know the topic is superb!) By discussing what was reviewed in these sessions, I think we can get great input into our OT Identity.


"What is occupational therapy?"


How often do we hear those words?! Yet Toto points out that each OT area has its own definition. What I do on a daily basis in the school system is nothing like what I used to do in the hospital and that would look nothing like the life of a hand therapist. Even within the hospital, my practice could vary widely from the NICU to the Neuro ICU to the orthopedic floor and so on ad nauseum. Toto said this was like blind men describing an elephant- we tend to describe our practice in a reductionist way of what we regularly do, sometimes missing the big picture of OT. This can lead to confusion from consumers, referrers, and payors. Amini points out that if we want to achieve the Centennial Vision goal of a consistent recognizable image, we much EACH take it as a personal responsibility. The "Authentic" version of OT is client centered and occupation based, with occupation as both an outcome and a treatment. Amini pointed out that this is often an espoused belief of practitioners, but not necessarily an enacted one.


A person may not even realize that they aren't enacting their beliefs until there is an additional level of reflection involved. Amini described reflection as thinking and critically examining yourself, skills, and practice. Reflexive practice takes reflection further by then comparing reflected behavior to espoused beliefs, determine any incongruence, and then act to change the behavior or the belief. This process can be done by personal journaling, mentoring, using the AOTA professional development tool, creating a portfolio, or joining a community of practice. Toto states that one of the best ways to advocate for OT is to practice consistency in areas you address, services provided, assessments and intervention approaches. In doing so, you create an image that others will remember and identify as occupational therapy.


There are perceived challenges to authentic and reflective practice. Amini includes corporate policies, reimbursement, productivity, supply cost, time, and decreased support from peers or supervisors. Toto described threats to our practice: complacency in our documentation (failing to specify our unique practice), viewing OT as a job instead of a career, moving from ADLs to preparatory/adjunctive treatments, accepting the status quo (including that laid down by the boss), and allowing any other service to be a "gatekeeper" to OT. Don't allow other professions to represent you. If your services are special and unique, NO ONE can say OT isn't needed! Remember that documentation is important. It's hard to remember that when you're writing 6 evals a day and don't think they're ever read. But think back to being in school when you learned about how each note was a legal document, the only proof of what really happened with a client. Toto discussed that it is important to use our practice framework language and reference evidence in our documentation. The most skilled part of a person's OT session may not have been the hands-on portion, but the clinical reasoning and decision making you engaged in. And speaking of clinical reasoning- don't short sell our value by saying that it's just "common sense!"


Toto discussed at length the importance of advocacy for OT. We're great at being advocates for our clients to get the best care, but more reluctant to stand up for ourselves. There are a limited number of healthcare dollars, and other groups would love to take our share. We can't be timid and "nice." As Dr. Clark said in her presidential address, if you let others take OT for granted, "it's not playing nice, it's playing dead!" Remember, there is no mysterious "they" who will advocate for you. AOTA and your state association may be able to take action on a government level to defend OT, but without your membership, they are hard pressed to do so. And they certainly won't be coming to all your referrers and coworkers and asserting the OT scope of practice. That falls to each of us. Amini reminds us (especially those AOTA members) to use the official documents as leverage during advocacy efforts.


Toto described that there are two ways to make light- you can be the candle or the mirror. When your client is successful, they need to understand who you were, what you did, and how your intervention has impacted their occupations and participation in life. Discuss and hand out goals. Hand out a business card. Make sure that you identify yourself as an Occupational Therapist and not just an OT or OTA. Have several elevator pitches for different audiences that include evidence. Most importantly, let everyone know the good that you do, so that others may receive your awesome authentic services.


I hope you find these points useful for your daily practice. The field of Occupational Therapy and our consumers will definitely benefit from authentic practitioners. Let's all strive for that in the coming week.


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Dycem Product Review

The good folks over at Dycem were kind enough to send me some free samples in exchange for a review. Click through to read (and win a prize!)

Dycem products have expanded since I was in school, learning about their use. They have even made a special section on their website just for OTs. I got a few products and started trying them out in my practice and handing them out to others.

I was a little confused by the mat that had a peel off on both sides. I am 80% sure that it was just like that for easy distribution and cleanliness, not to be adhesive. (There are adhesive strips/mats as well) I tossed one of these in my utensil drawer, because the force from me closing the drawer kept knocking the silverware tray back into the depths. I put it in a few weeks ago, and despite me purposefully slamming the drawer, the tray does not move. The silverware itself keeps trying to run away, but I digress. We will also use some for either the drawer holding baggies or for where the wine glasses are.

One of the rifton chairs at school has a piece of Dycem on the seat to help keep the child from sliding. This does work, but you have to be very conscious that you are positioning the child properly and with a good pelvic tilt since it will be hard for them to readjust themselves.

I like the coaster a lot. It doesn't slide on the surface and the glass doesn't slide either. The downside is that it cannot absorb any liquid, so the glass will get pretty drippy if you have a lot of condensation. I tried to use this in the car to hold my phone (illegally) on the dashboard, but it couldn't quite hold the phone during the turns.

The pediatric mats are quite cute. However, the shape cutouts can make it difficult to get the absolute best fit for the object getting stabilized. I have used the Turtle while in the schools, stabilizing slant boards, the Ipad, blocks etc while on the wheelchair tray or tabletop. The kids seem to like it, but it can be a little distracting. I sent the hippo to my grandma because her little fat dachshund dog is so eager to get her daily food portions that she attacks them and pushes them under the toe kick for the kitchen cabinets. This is annoying for my grandma, who really shouldn't be bending over and digging under the cabinet or all across the floor for these bowls. She swapped the old mat for the dycem one and has not had a problem with the bowls moving at all. I got a text message ("from the dog") that reads- "Dear Cheryl, I like my new mat. I don't have 2 chase my food dish. It is easy for my maid 2 pick up and clean. It doesn't take up as much space. Thank u for thinking of me. love, Annie"

The jar and bottle openers are my favorites by far. The jar opener has worked on everything I could try, and my elderly patients have always liked it. It is listed at $12.75, but really high quality. It is much better than the rubber or silicone trivets/openers I've tried before. The bottle opener is a little redundant, but lets me open my adult beverages without assistance.

Keep in mind, when using any of these products, your results are much better if the surface and the product are both clean and dry. I have to keep the portable mats in boxes so that they can be transported without getting nasty. It just takes soap and water to clean. I tried to use the placemat "off label" as a trivet. I wouldn't recommend it for that. It's better than a towel, but does still transfer the heat as time goes on. I actually checked the specs and material is supposed to be OK up to 50*C, but I like my silicone trivets better for this purpose.

Things I didn't try:

- On the website, you can see small furniture disks to keep chairs from slipping. I would be interested to know whether this provides enough stabilization to someone who is really pushing back hard on the chair (like a person with Parkinson's). I suspect it would depend on the angle of the push- might be ok for a person who pushes straight backward, but most are at an angle that causes the chair to tip back.

- Also on the website, they have a picture of a sheet of Dycem on a hospital bed presumably to keep a person from sliding down the bed. Would this really work? Soft surface of sheet plus either soft hospital gown or skin? I don't know that I would try it.

- I didn't have one of those mats to try out with sit-stand transfers. It would probably work with some, but the ability to adjust the person's feet is sometimes needed. Could still be useful.

If it were me, I would expand the product features in a few ways. I think the openers and the coaster could be more accessible if there was a magnet or clip to attach to the fridge or cabinet drawer. The jar opener could probably be made into a ring only and attached to a keyring for tailgating purposes. Some products could be integrated with others to increase their function. A silverware drawer with Dycem lining on the bottom and insides would be helpful. A coaster that could somehow have a cork middle to be absorbent while still retaining the non-skid would be great. Anything that could tolerate high temperatures, microwaving, or going through the dishwasher would be helpful. And more color choices are always enjoyed.

I really don't know of an alternative better to Dycem. It just works.

Free Giveaway!

Thanks for reading this far! Please leave a comment regarding this entry or the blog in general (polite only please, no email addresses, no spam plugging fake universities, etc). Get these in by 11:59pm (EST) Sunday November 6 and I will use a random number generator to pick a winner(s) and mail you a slightly used but not damaged Dycem product. You can also get brochures and free samples here.

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Life is what happens when you're busy making other plans

So, I work in the school system now.

I know, it's a big change. But it's not like I had anything else going on, what with the moving, quitting another job, buying a house, and moving again. Late summer of 2011 is rivaling the entire summer of 2007 for most stressful time of my life... it has already surpassed spring/summer of 2002 and that is really saying something. (sidenote- why does all my stress come in the summertime?!) So to sum up, we moved from Baltimore to have a more stable home/family life, I tried to make it work at a job, and I finally got an offer I had been waiting for, so I made the switch. And I now know that you should NOT EVER switch jobs while trying to purchase a house. Loan people don't like that. It also ended up being a much more prolonged departure from one job to the next.

In 2002, or even 2004, or probably even much of 2007 if someone had told me that I would be working in the school system I would not have believed them. Until I had already taken my first job and kind of fell into the world of outpatient pediatrics, I really didn't know that I could find working with kids interesting, important, and fulfilling. I liked kids in short doses, but it wasn't something that I thought about doing for a career. That opinion played a BIG role in selecting the University I went to for OT... I was completely turned off by a big-time program because of what I felt was an overemphasis on pediatrics. I liked outpatient well enough, but never thought that I'd move to school-based therapy.

For the record, I'm pretty sure my mom brought up school system therapy back when I was still in high school, so as usual, YES Mom, you're right.

I haven't been working in the current situation very long, but so far I have just loved it. Great therapy staff and everyone has been very helpful as I get my feet under me. About a month in and I'm starting to get the rhythm. I think the biggest challenge is the scheduling... I have preschoolers that are only present 2 days/week, and then only for mornings or afternoons, travel between locations, meetings, all that jazz. It's coming together.

I love the resources that are available at work. Lots of different assessments, and multiple copies of the popular ones so you don't have to fight with anyone else to schedule testing. A variety of adapted writing tools and alternate seating surfaces that you can just give away as warranted. I think it's great not to have to jump through hoops to get things ordered or recommend something to the parent and make them have to order it.

Had a great weekend with the NBCOT crew, working on simulation questions. We literally go through each word to make sure that the questions are clear, not trivial, not tricky, and not biased. It can be intense, but I am glad to be with such a good group of people. I enjoyed the time in Memphis, particularly running by the Mississippi river, which I had not seen before. My only regret is not getting to go on a sternwheeler, but I didn't see the Proud Mary anywhere, so it's not like opportunities were abounding.

he house purchase process was overwhelming... which is an entirely separate post. (coming someday! I promise! Already started!) But I have been keeping with the recent change in focusing more on personal health and non-OT stuff for a change. I am still running (mostly regularly) with a 5K at the end of October. We've been hanging out with friends during the week more and settling into our crazy fall routine of traveling almost every weekend. Serious miles are in the near future at a time when rest would be most welcome... oh well. At least there should be fun times with friends upcoming.

I'm going to try not to neglect the blog too much, especially since people have been introducing me as the blog girl, and it would be bad form not to update. :) But patience is always appreciated.

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Self Behavior Modification

So as I work on getting in shape, I worry about maintaining motivation. There have been a number of failed attempts prior in my (not that long) life and I'd rather not fail again. So I am busting out behavior modification all over myself to make it work. There are some great tips here, and I've listed out some of my other methods of personal mind control.

(not necessarily in any order)

1) Visibility-I want to be reminded of my goals and what I know I should be doing. So everything stays visible. My box of exercise gear (yoga stuff, balance stuff, aerobics shoes) is right beside the TV, so I always see it. If there's an exercise DVD that I want to concentrate on, I'll prop the case up by the xbox so it's easily seen. We have no garage at the moment, so the bikes are sitting right beside the table. I bought anti-chlorine shampoo for post-swim workouts and put it in the front of my shampoo container so I see it every time I walk in the bathroom. You could also place motivational notes to yourself in various places.

2) Ease of access- Since most things are visible, they're easily accessed. I have Netflix streaming and leave all the workout routines in a block so they're easier to locate. The running shoes stay near the door and untied. I keep my water bottle filled and in the fridge. All the workout clothes are in the same drawer, and if I'm planning on going to the pool I'll put all that stuff in a bag together. Generally keeping necessary accessories (say that 3x fast) together makes life easier, for example, the bike helmet is on the handlebars. I'm a bum, the easier it is, the more likely it is to be done.

3) Guilt- Is this a healthy motivator? I don't know. But I use it. Thinking about the cost of items, and that I really should use them, is sometimes helpful. Thinking about how long it has been since doing an activity is also something I do. And in the part guilt/part competition factor, if my husband/workout buddy is doing something, I will try to go along and keep up.

4) Mental monitoring- A recent study showed that people who just mentally asked themselves "how often will I work out this week?" worked out more often than the control group. (sorry, no link) So I try to think about my exercise schedule, and try to think how I will fit things in for the following day. I also am trying to keep a journal with short entries about what I did and how I feel. Keeping a written record gives me something to look back at for motivation.

5) Rewards- I am all for cheap, easy thrills as rewards. I have a smart phone and use the free CardioTrainer app for my exercise recording. Every time I turn it on, I can see a little activity figure for each day that week I did any kind of exercise. I like the little stick figures and think that they're cute, and like to see a variety of them on that screen. It keeps a full history, so I can look back and see how many total miles I have gone since starting the app and the calories for each. I can also see the maps of my outdoor exercise, which I think is cool. Finally, there's a widget for my screen that turns different colors based on # calories burned/week. I see it frequently when using my phone and always try to keep it in the gold/silver/bronze range. I definitely get a little emotional boost when I see a good color.

So that's a few of the ways that I've been manipulating myself lately. Nice to see that I'm making use of my education. Any other good tricks that you use? Feel free to share in the comments.

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Disability or Ability- TV's Alphas

I watch a fair amount of TV. Now that I'm home 2 extra days, I keep it on for noise during the day. One of the shows i have started watching is Alphas from the SyFy channel.

Alphas so far appears to be a fairly standard superheroes kind of show in the line of XMen, Heroes, etc mixed in with some espionage and spy work. I like those kind of shows, so I can tolerate some of the less-than-awesome dialogue and recycled plots. Of the 5 types of Alphas described, even mild comic book or superhero fans could list other characters that fit these types.

What spiked my interest in the show was the character who is a "transducer" and able to act as an antenna to intercept and decode messages. "Gary" is able to read all wavelengths- TV, cell phones, computer traffic on the internet, etc. This is an astounding amount of information to absorb, but he is able to help break codes and find information for the rest of his Alpha team. In daily life however, he appears to be on the autism spectrum (some episodes more severe than others), getting assist from his mom or team members for many daily tasks. In a follow up episode, a new character is introduced who is a human "Rosetta Stone," capable of understanding and translating any language, but also considered autistic by those not familiar with Alpha-skills, since she is unable to make eye contact or communicate except by making seemingly random scratches on her hairbrush and other materials.

I won't say that the depictions offered on TV of a person with autism are entirely realistic. I've only seen 2 episodes, but even within that time frame, Gary's eye contact, speech patterns, social skills, and repetitive motions have changed considerably. Some of this is likely due to the actor becoming comfortable with the character, and the changing demands for different episodes. But I particularly like the concept that a person considered disabled in the context of average humans is valued as a superhuman by those "in the know." Which makes labels like "disabled" or "dysfunctional" worthless, since the ability (especially in this case) is all in how the person is treated and enabled. A not too deep encouragement for us to look past labels and prognoses and focus on abilities.

PS- I believe that Modern Family features a character with autism as well, but despite some of my friends liking the show I have never seen it.

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thoughts on starting exercise

So I've gotten on the exercise train for a first time in a long time. And I have boarded a new train heading somewhere quite outrageous...

This is my first announcement in a public forum, but here goes. I intend to compete in a (sprint distance) triathlon next year. I'm not particularly fit at the moment, and can't yet do any of the distances for the 3 disciplines on their own, let alone consecutively. It's a process. My husband has decided to join in the fun, so we are both engaged in these struggles that can be both harrowing and ridiculously funny. There would be plenty of material for a knee-slapping gut-busting book or stand alone blog, but I just don't have time for that (how can I, when I already neglect this blog too often?) so I may share some of these stories in this forum.

On our journey to becoming athletes, we have already had a bike push (definitely couldn't be considered a ride) up and down a rain soaked clay hillside; a 2 hour hike into a canyon that required fording a river and another 2.5 hours to get OUT of the canyon; and a realization on my husband's part that swimming after a long bike ride is puke worthy. He has a serious strength advantage on me, and much greater skills in biking by extension, but I have the advantage in swimming thanks to years of lessons at the YMCA (thanks mom & dad!). So I learned a lot of technique as a child that I am now trying to impart to him as an adult. It makes for an interesting take on the difference between learning styles based on age.

The biggest technique piece so far has been introducing rotary breathing. It's a difficult concept for a novice swimmer. Those words were like poison to me for the entirety of 1994. It took me what seemed like a lifetime of 1x/week screaming by unpleasant swim instructors to be able to put my face in the water and master this concept. So even as an adult, when I (prior to the past few weeks) swim only 1x/year, I still can pull that out easily, like riding a bike. Since my husband wants to be able to finish the triathlon too, it was a skill he needed to learn.

As a child, (obviously I wasn't paying the greatest attention to instructional detail at the time) the instructors specialized in breaking down the steps to the task and repeating the practice in various ways. Blocked practice. First, kicking on the side and blowing bubbles. Then, kicking with the kickboard and doing head turns to one side. Then putting it all together into the crawl stroke, which you now have to do since we've thrown you into the deep end of the pool. (I'm having terrible flashbacks trying to write this, even now). Ultimately, until I got a new teacher and went from weekly practices to daily practices, progress was minimal at best.

My husband doesn't really have the attention span to do nothing but work on breathing for an entire hour in the pool, and approaching this from that angle might mean that he would never master it. So I gave him a few tips about how to turn his head while taking a stroke. (In retrospect, this probably shouldn't have taken place in the ocean, but like I said, we are having quite the funny journey). Then I would either answer his questions ("am I supposed to breathe out at some point?") that I hadn't covered earlier or offer some technique feedback. More of a contemporary motor control theory for learning, letting him practice and try on his own. After a few sessions (<5) he feels like he has a rhythm, and even if it doesn't look perfect, he is still able to crank out lots of laps while taking in more air than water.

So what did we learn here? Obviously, having an OT for an instructor is terrific! :) Personally, I think that learning the skills as a child made them well ingrained into my muscle memory and expect that to be unforgettable. It took a lot longer time for me to be able to learn and integrate that skill though as a child than it took my husband as an adult. But I think that the longer time to learn will make it harder to forget. It was easier for me to teach refinements to an adult than for Ms Pam to teach basics to a scared child who could barely stand up in the shallow end. I could compare this to different motor learning theories, but my books are all in boxes anyway. :-/

Well that was a bit rambling.

Personally, I am trying to take a balanced approach in this fitness plan. I really don't want to get an injury or derail this plan in the first month. Trying to add in workouts for flexibility, core, and overall strengthening into this plan. It's really hard to find time and motivation for all of this (and I have no kids and a 3 day/week job) so the ultimate goal seems very daunting at this time. Hopefully I can pull this into line (along with the rest of my life... house shopping, OT presentations, new job, other endeavors etc). And if I come up with things that are potentially interesting or tangentially related to OT, I'll try to share.

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In the throes of ... lots of non-OT stuff

Life goes marching on...

Since the move, we have been trying to focus on more family time, and that has transitioned into an increase in athletic endeavors, which has been also going along with work on healthier eating. So there have been a lot of changes that we are trying to turn into healthy habits... a personal "lifestyle redesign" project, if you will. I'm not being super smart about things though since I've made lots and lots of goals, too many to focus on all at once, and no time frames. Also trying to buy a house, which is an insanely-detailed process.

I've only worked 4 days at my new job (a 3 day week and a week long vacation does make it hard to accumulate time, haha) but I feel like I'm starting to get the hang of things. There are computer and written portions of the documentation. It's a new computer program for me, and it will be interesting to see how all the documentation moves to computer (I consider it only a matter of time for all sites... it is the 21st century after all). There have definitely been some great moments with the residents and I hope that things will go well.

Ultimately, I would like to start a Lifestyle Redesign styled program in the assisted living facility. I have gathered some research to use in marketing, but need to review how to do a needs analysis, decide whether to pursue grants, etc etc. I would REALLY LOVE FEEDBACK on getting this started.

I've been keeping busy on my "off" days, which is kind of bad since I have plenty of OT things to be doing during that time, but there is a lot of ebb and flow right now. things will likely get done, just a little off the ideal schedule.

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I'm Alive!

It has been WAY too long since I last wrote. Here is an abbreviated update:
1. I moved
2. I'm starting a new job
3. I have irons in the fire.
For more details...
I had to say goodbye to Baltimore. Logically, I know it's the right choice, but it has been crummy. I love the friends that I have made and the excitement that Baltimore offers, and there were so many cool OT opportunities as well. But from a personal and family standpoint, it was just not sustainable in the long term. Commutes were too long (60+ for me and 85+ for my husband) and we needed 3 days off to get home and back since we were so far away. So with potentially wanting to start our own family (in the next few years) something had to change. But knowing that logically doesn't mean that it's been easy or something that makes me happy the whole time, so I have been withdrawing a bit and trying not to put my foot in my mouth.

By extension, since we are moving a significant distance, I have to change jobs. I am at a point of conflict, since I feel like I've learned a lot from working in the hospital and am good at what I do, but it doesn't always make me happy. I don't always get to spend the time I would like to with the patients, and fighting for the appropriate recommendations really wears me down. Sometimes, there's this feeling of standing in a vacuum screaming without anyone hearing. With such little time to work with people, sometimes I wonder about making a difference. This had been better lately on the neuro floor, but it's still frustrating. I still like the hospital environment, but I don't see myself returning to it full time, maybe just prn sometime in the future.

So in thinking about what I'd like to do long term and think that an outpatient environment might be a better fit. I hate making this change without my awesome outpatient buddy from my last 2 jobs directly by my side but hope that we'll be able to keep in touch. The job I'll be starting is a unique outpatient setting that is small relatively new- only been in existence for a few months. I'm excited to help with growing the program and learning how to navigate the new environment. It's a part time job, so that will be flexible enough to let me have time to keep up with my OT extracurriculars and other activities.

On the irons in the fire list, I submitted to 3 conferences in June. 2 presentations will be similar, so that will be helpful. I get to work with an awesome group of OTs for the AOTA presentation on social media, so I hope that will work well. I have been dealing with the whole host of lame stuff that has to be done when you move, including living out of suitcases and sleeping bags for awhile, cleaning, unboxing, tons of laundry. Definitely not my favorite things to do, and having to mooch internet from Cosi was not particularly convenient for updates. I had a crushing crescendo of activities and deadlines that culminated with my last day of work and a week at the beach, and I was so wiped out. Disconnecting from the computer and internet was needed so I could recharge physically and mentally. I am feeling better now.

I intend to have at least 1 post per week now that I have some scheduled days independent of work. I hope to cover some of the following topics, and if interest is expressed I can try to speed it up:

new acute care book on AOTA press

portrayal of mental illness in Broadway's Next to Normal

new shows with characters who have disabilities

thoughts about Lifestyle Redesign program

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