The kids are growing...

My pediatric caseload is starting to grow considerably... I've been evaluating 1 or 2 people a week for a couple weeks and have about 3 more weeks of such already lined up. I've had to start doing 2 afternoons a week (split between hospital and peds) and may need to go up to 3 days. (This situation would be a lot easier if I didn't hate hands and the typical outpatient environment)

Anytime I get to feeling like I'm gaining a handle on peds practice something makes me realize that I still really don't know what to do sometimes. Little Miss A has CP which has affected her right side. I have some weight-bearing and BUE movement goals. But when we're involved in activity, it's hard to know what to focus on, even when I'm just focusing on her right arm. I only have 2 hands myself, so do I supinate her forearm, extend her wrist, or extend her fingers?

I told my boss from the onset of taking the entire pediatric practice that I really would need to get some good CE so that I could be more informed and prepared for these new responsibilities. I've been exploring different things but still haven't decided. I really like the idea behind the Alert program, but most of my kids are under the recommended age of 8 (a range closer to 3-7). I've also been looking into the Miller Method for kids w/ autism spectrum and the Interactive Metronome which claims to be for kids with various problems and also adults. Obviously, for it to be worth my while it needs to be effective for a kids of all ages and diagnoses, preferably evidenced based, and not require expensive or specialized equipment to implement. If it will coordinate with the few standardized items that we have (Peabody, Infant/Toddler Sensory Profile, and 1 Handwriting without tears book) it would be all the better.

I'm open to suggestions or information from anyone who's worked with these programs and willing to lend some advice... as the caseload grows it becomes more and more important to take some serious action.


Why everyone should go to the AOTA conference

... at least once every five years.

I had the great fortune to be my school's representative to the assembly of student delegates for the 2005 conference (Long Beach) and was then able to have the funds and time available to go to the 2006 conference (Charlotte). As conference registration is now open for this year's conference at Long Beach, I thought I'd share some reasons why everyone should make an effort to attend a few times in their career.

5. Expo: The expo is quite a fun activity... a great opportunity to apply for free drawings, get free goodies, and good for job searches if you're looking for local or national placement. I didn't spend a tremendous amount of time at the expos, but still had time to collect a lot of fun and informational stuff. (I also won $100 from Huntington Rehab in California!)
4. Support: The area conference committee goes through so much time and money to make each conference memorable and awesome to the participants. Attending is a great way to show your support of the national organization, and the local area.
3. Connect: There is no better venue to allow OTs from all across the nation to meet and share common interests. This is a great time to further investigate a specialty of the field, a well known employer, and exchange ideas with some of the best US OT minds. Most of the speakers, book signers, and honored guests are at the conference for the duration- and they all wear nametags, giving you the great opportunity to talk to any of them.
2. Learn: I am learning firsthand that it can be very difficult to find CE that are in your field of interest, affordable, and local. In my 2 years at conference, I was able to easily pick up 15+ contact hours each year in topics that I was truly interested in. This was also very helpful as a student... I held onto abstracts and handouts from the presentations I attended and when I later had a presentation or paper on a topic for school, I would reference that presentation or contact the author for more information. If you are branching into a new practice area, or coming back into the field after a long absence, the immersed learning you can get at conference can really help with the transition.
1. Recharge: When you attend conference, especially the big events such as the welcome or Slagle lecture, there is a pulsing, dynamic energy in the crowd. There is an air of excitement evidenced by dancing in the aisles and grins all around. People drop their guard around fellow OTs and old friends, and create a great environment. The daily drudgery of paperwork and long hours can take its toll, and conference is a great place to remember why you became an OT and where you want your career and profession to go.

So there you have it, my friends, great reasons to attend conference. Since the location varies each year (usually East coast, Midwest, West coast), there's a good chance there will be a conference near you soon. I have some great memories from conference, and each year they are continuing to add extra benefits of attendance. I know the price can be offsetting for some, which is why you should wait for a nearby conference to attend, and/or make it part of your vacation. I will later do an entry on how to get the most out of conference without breaking the bank. Entry title is linked to '08 conference registration.


Methods to the peds madness

As someone who is used to working primarily with adults, the lack of structure that seems to occur with peds treatment sessions can be confusing and frustrating. When I evaluate an adult, I can rate their performance on a number of measures quickly and easily. In an hour, I can easily complete my facility eval, get FIM ratings, grade an MMSE, and even an interest checklist or such if the mood strikes me. And as they improve, I feel that I can document that effectively, using those measures or others. But with kids, it's a whole new ballgame.

We do not have a lot of standardized assessments or methods that are routinely used at my site. The only non-facility assessments that we have are the Peabody (which does technically contain treatment ideas), and the infant/toddler/school age sensory profile. These have been used pretty sparingly in the past. I did manage to find a box of Handwriting without Tears (HWT) materials, which to my knowledge has never been used.

I find this frustrating on multiple levels. For one, taking over an entire caseload without the support of the previous therapist is difficult, and having no standardized measure of client performance at the eval makes it hard for me to come in 6 months later and determine progress. Secondly, I wonder how much carryover there has been between the previous therapist's treatments and mine, what works better or doesn't work. With OT so often ridiculed as a profession with no basis in research and all in anecdotal report, consistency and measured improvement seem like they could only help matters.

Of course, I know that it's more important to work to the child's own personal needs rather than spend a great deal of time on testing or cookie-cutter treatment. And I also know from experience that trying to administer a standardized test to a child is a hair-raising and time-consuming experience. But especially if you have more than one therapist seeing the child, doesn't having some sort of truly objective plan help you really know how they're progressing? I'm seeing this issue especially in handwriting performance. I know little about previous therapists' methods for our shared clients... I know that there was some hand over hand work, some connect the dots, some tracing... but it's hard to say exactly what was working (this is probably also related to documentation, but that's another topic). Today I got to try some HWT methods with a kid, and actually felt at the end of the session that not only did we make progress, but here was something I could easily have a replacement therapist do and be assured of same presentation.

Is anyone else facing difficulty objectively evaluating peds? The subjective and qualitative changes are great, but I feel like I'm likely to get an improved understanding by non-OTs when I can show quantitative changes. What about the issues with carryover between multiple therapists, same patient? What are some great (or awful) tools that you're familiar with?



I never realized how there are regional dialects of OT until I moved across the state and started interacting w/ people from multiple different OT/OTA schools. For example, when referring to the national testing board, people from my school always pronounced each letter (N-B-C-O-T). Yet, over here, the people from the OTA school nearby always say "Nibcot."

But no matter how you say it, thoughts of NBCOT can frighten just about any sensible student. Crawling through the gauntlet that they've created can be difficult, but few lose limbs in the process. Here's some tips that'll keep you from losing extra money and sanity though:
  • Name Game: Several of my classmates and I got married after graduation. Changing your name is hard enough, changing it w/ NBCOT can cost you big bucks. Either register before the wedding and delay changing your name until after the test, or register for the test after you've already changed your name. AVOID at all costs registering under your maiden name and then trying to take the test with your married name.
  • Forms: I believe that the ACVF form can let you register for the test immediately after graduation. That will give you time to get your transcript sent, and until the board gets that, forget about getting your scores.
  • Know thy Licensure Act: check in with your state board to get a jump on temporary permits or your license long before you want to work. Make friends with the people in the state board office so that they can guide you through the process. (shout out to Vonda)
  • Prepare: I may do a full test-prep section some time, but until then, here's my basic guidelines. Take a practice test, and review it so you can ID your weak spots. Brush up on things you forgot or don't recognize right off using your main textbooks. Don't procrastinate.
  • Post-Test Patience: perhaps the hardest part of the process... the waiting game. This is where it is to your advantage if you don't have a current job. Try to relax after the test, though you will inevitably feel awful. Don't panic, don't second guess.
Navigating the bureaucracy of the national board can be difficult, but keep your cool as you go through the process. Turn to your teachers, classmates, and most importantly the office folks at the board. They can help you get through the complicated parts- because that's their job. They're a free resource, even if you do have to get stuck on hold all day to get to them. Best of luck with the initial prep!



Undoubtedly, someone who knows me is questioning how in the world I got involved in peds. It's true, I never thought that I would be a pediatric practitioner, even though there are thousands of OTs who want nothing more than to work with kids. It's not that I don't like kids... but I always stated that I would want to work with adults, who could be reasonable, and who would want to participate so that they would improve their function. Now that I've gone through school and have several months of working w/ adults under my belt, I realize that they are not all reasonable, and even the ones that are don't always want to work anyway. I'm with a lot of elderly people right now, but despite the great stories you can get from the patients, there are times when treatment can get downright boring. (sigh)

This realization in and of itself wasn't going to drive me to the opposite end of the spectrum. But there has been a lot of turnover at my location in the past year. After I first accepted the job, the pediatric therapist resigned. I was left to supervise a COTA doing most of the peds clients, mostly just doing evaluations. Then, after a couple of months, she left too. With no other coworkers even vaguely interested in doing peds, I was left holding the ball, so to speak.

So, what started as me being stuck in an uncomfortable situation that I wasn't ready for, seemed to evolve. What I wasn't originally interested in became the challenging part of my job that makes me work harder and actually find fun. There are moments where it actually makes my body ache - crawling on the floor, hoisting kids around, getting hit in the head - but there is actually a lot of fun involved too. My first real observation of an OT was in a pediatric setting, but I never thought I would be able to do it, or enjoy it.

I'm finally starting to see how this section of the profession can be really rewarding. As with all patients, sometimes the littlest gains can make you most elated. Here's a little story of one of those tiny successes:
Little Mr. O has been coming to therapy as a 2 year old w/ developmental delay. I reevaluated him with the Peabody last week. I felt like an idiot because he scored so much lower than I thought he would- about a year behind in fine motor skills. I was dreading having to talk to his mom. I went out before the session and tried to be positive, emphasize his strengths, outline our new goals. She was unhappy, I was unhappy. But I went back to the play room w/ lil' O and started some sensory stuff. He was playing with a little nobby ball and I could see a light go on. He immediately ran across the room, and opened the top on this little desk that he sits at during some sessions. He opens it up to this little pegboard you can stick letters to, touches it, touches the ball, and has this expression of "THIS IS THE SAME! I KNOW IT!" (he can't talk, so that expression was worth it all) It was so nice to know that he really is developing and that there's all kinds of cognitive action in him, and that I am so close to reaching it.


Welcome! As this blog is very very new, you probably know me and are at least somewhat familiar with my life. You may have followed my previous journal keeping and (though I doubt it) looked forward to my return to typing about my everyday life and opinions on everything from sports to politics. However, I would someday like to have people that I DON'T know read this blog and find interest in it. So I will be keeping all those personal (and probably not very interesting) issues off of this blog if they do not specifically relate to my profession. Never fear- I will continue posting photos, political thoughts, personal updates, and all the other fun stuff in other outlets, at this point probably facebook.

Here is the outline of principles for this blog, and I will try to be accountable to these.

  • Information about OT
  • Issues important to the profession or the clientèle
  • An occasional chronicle of my professional development and everyday adventures as an OT
  • Advice to my peers and future professionals about practice and school
  • Stories from my job meant to evoke thoughts, emotions, and inspiration
  • A forum for me to gripe about work, coworkers, clients, friends, family
  • A photo album of my personal life
  • An area of negativity
  • A HIPAA violation
  • An outlet for my random thoughts on everyday life
  • Read, enjoy, and share with those who have an interest in OT, healthcare, wellness
  • Provide your comments to help advance discussions about important issues
  • Avoid negative attacks on me, other commenters, OT
Thanks for reading and participating...