Products I <3

When reading some of Karen's posts about peds friendly products, I thought about some of the things I've been using and like too. I've included a lot of pictures of crayola products, not because they pay me (or send me free samples), but because they seem to be on the edge of developing the kind of tools that are great for the kids.

Pipsqueeks Markers: these are becoming more and more mainstream and I love the fact that someone bought these for our facility before I started working there. The small size is so much easier to elicit proper grip with, and the colors are quite cute.

Heads n Tails: These are similar to the Handwriting w/o Tears crayons that facilitate in-hand manipulation

Twistables: I included the Slick Stix here because they require very little pressure to create vibrant color. The twist factor also continually elicits fine motor work w/o breaking out rote twistable manipulatives (nuts and bolts)

Stetero Grips: Put your thumb on the star and get a great grip. Doesn't get much simpler than that, I plan to send several kids back to school w/ these.

Tactile Stim Pencil Grips
: I personally love these- be they foamy, bumpy, squishy- anything but sticky. I found terrific mini mechanical pencils w/ grips already on them at KMart and use them for all my Alert Program kids. Fatten up your favorite writing implement and give yourself something to touch.

Wikki Stix- made to work on handwriting, but I love using these to teach shoe tying. The stickiness is great to build up a tactile defensive person's tolerance for unpleasant stimuli.


Here's to you, Mrs. K

My Mrs. B is off to acute rehab. Despite the PTA's view that "it won't make any difference," I think that she is capable of great recovery. This week, she was able to don her bra independently using a clothespin to hold it to her pants, participate in the modified pilates for neuromuscular reeducation, and complete a shower with more ease. We did the resistive clothespins on her second to last day, and she was able to independently seek and manipulate all but the hardest pins, a drastic improvement from Day 1 (which I did get to see). I got to say goodbye and give her a hug, and she was so appreciative of me... it was so sad because I formed a strong bond with this strong lady. In retrospect, she reminds me very much of a patient I worked very closely with at the end of my rehab fieldwork- Mrs. S. They are different in diagnosis (Mrs. S had a FOOSH which resulted in a R wrist ORIF and R hip replacement) but both have a great drive to get better. Even though the healing takes longer, since they were both in their 80s, I believe that they both did quite well with rehab, and do miss their special personalities. Thinking about it also makes me wish I was back in the intensive rehab world again, and makes me worry about whether I have the chops for that anyway.

Sadly enough, as my dad would say there's always an object lesson. Mrs B was the patient who alerted me to how my changed pediatric schedule and personal focus has affected the inpatient environment. I was able to work with her less often than I wanted due to my peds schedule and the responsibilities that come when working on a small staff. I was only in inpatient all day 2 out of my 4 workdays, and one of those was often spent entrenched in acute care evaluations. Not only was I working less w/ Mrs B, I was also working less with the patients down "my" hallway. The division of hallways was setup about a year ago, and obviously is still in play, though my peds schedule has had a strange effect on it. Since I was not around to constantly direct care for "my" patients, they got fewer ADLs and less personalized care from the rest of the staff. I found weekly updates hard to complete, and little attention was paid to the altered treatment plans.

I feel terrible about the decreased level of care that I feel these people have gotten, but it's hard to understand how others' complacency let it get to this point. I will have to spend the next month (until school starts) advocating louder for their needs and paying greater attention to their treatments and developments, even if I never get to see them. Who knows what effect the school year schedule will have... I've been adding kids left and right since June and will have to make spots available somewhere, while still carrying a full hospital caseload.

I hope I can get all this worked out... I am trying to worry about it less so that I have more mental peace. But good luck Mrs B- may those at the county rehab recognize your special light and help you achieve all that is possible.

I used too many abbreviations today, here are some explanations if you're unfamiliar with any of them: PTA- physical therapy assistant; FOOSH- fall on outstretched hand; ORIF- open reduction internal fixation operation.


Parental Ratings

There are times when I really worry about the choices parents make and how they affect their children. Usually, this is associated in my mind with parents dragging sick kids to therapy, or skipping therapy, or over-therapying. But this time, I got to witness some parental slack outside of the therapist-client relationship for a change. I was at the movies today, watching The Dark Knight. This movie is rated PG-13 (though I really don't know how it escaped an R rating). In case you are living under a rock, this is not your grandpa's Batman, and this is a very intense movie (for proof, see the nail marks on my husband's arm). I would hate to give any part of the movie away, but even in the previews, you can see that there are hostage situations, often with one person holding a weapon in the face of an innocent. Harsh. Brutal. Violent. Intense.

During a particularly graphic scene, my attention was diverted by the people in front of me, who exited briefly and returned. A mother, escorting her two children, ages 5-7. Seriously. These children will be like my peers who saw IT when they were little and still live in fear of clowns. Please... be the parent and let your kids act their age.


Pilates power!

Admittedly, I have been very terrible about keeping up with Pilates since starting the videos w/ my OT buddies during first year. I have done perhaps 2 10 minute sessions since last year, which is pretty pathetic. But I finally got to use some techniques w/ one of my stroke pts- Mrs. K. I had her doing an adapted mermaid while seated EOB. Really trying to bring back some normative movement in her RUE, as the natural flow is gone. It was hard for her, but she is such a trooper, really willing to work. Hopefully I can continue to incorporate these exercises for relevant treatments. :)


Busy times

Been pretty busy recently and only going to get moreso... GS evening camp is next week. I'll have to try to eat work early, wolf down dinner, and put on my happy face til 9pm. This is, of course, if I can get prepared. I have to spend this week making a sample of all the crafts, since it will take me that long to produce a decent craft. My fine motor is lacking... maybe I should have gone the PT route, though my gross motor skills aren't the best at other times. :-/

My favorite stroke pt, Mrs K, is now on the fast track to go to acute rehab from our SNF floor. I will miss her a lot, and really regret that my peds/acute care schedule has kept me from working with her more. I hope that her OTs and PTs at rehab can help her motivate and rehabilitate. (that should be a slogan!)

I have gotten the go-ahead to turn my handout on preventing occupational deprivation into a newspaper article, just need to add a summary paragraph.

Saw 9 kids yesterday w/ 1 no show. It was good to see my coworkers' kids last week to get a good reminder of typical development. I always rejoice in the minor progresses that the kids make, but it's nice to remember what we're shooting for. I need to get a better grasp of development, but not in the way that everyone suggests (Having kids!).


Stroke Season

One of my OT coworkers always says that as the heat goes up, the stroke rate goes up too. I evaluated 4 stroke patients yesterday. One was my friend from acute care who transferred to the SNF floor. Hopefully, I will get to continue to work with her and continue our partnership. I have a lot of cool treatment ideas for her right now and am working on a list to share w/ the COTA to get her more comfortable working with CVA pts.

Another lady came in and only speech therapy had been ordered on admission, but I got a referral the next day. She was a little defensive about me showing up to see her, but we took a nice walk and discovered that though she'd been having trouble reading (a major barrier to her preferred leisure activities) she could still recognize symbols and was about 70% on reading basic words. I picked her up solely to educate her on low vision techniques that would make it easier for her to read (fonts, more space between words, high contrast).

Had a very unfortunate gentleman in his early 60's who had a bilateral cerebellar infarct with a 1-sided thalamus infarct as well. This man had just started a new job, so it can be assumed that he was a reasonably active individual PTA. Unfortunately, his current assests are moderate head control, moderate ability to hold sitting balance, and movement in his L elbow and hand. No current speech production, questionable ability to understand others, and a mix of flaccidity and extensor tone in different extremities.

Last guy came in with minimal involvement- some slurred speech, decreased endurance, and slight proprioceptive and sensory deficits. He will go home soon, but there is some question to the future. The PT tried to allude to this with him by saying, "This might be considered a wake-up call" but there is little hope of him changing the behaviors that caused the stroke to start with- obesity, HTN, no exercise, no checkups with doctors, etc. People can change after such events, my dad did after his heart attack and now starts the day with 30-45 minutes of cardio exercise and a cup of oatmeal. But in order to change, you've got to answer the phone on that wake-up call. Here's hoping that this guy does so that I don't see him in 2 months in worse condition.

Title LGT the American Heart Association.


Being the therapist that inspires

I have pride today. Couple of days where I've been able to delve into projects and treatments and feeling quite good about it all. I've had some successes and am happy about it, so here's some notes on the whole business.

I've been working with a L MCA stroke patient and got to spend an hour with her today even though she is on acute care. Our acute care patients get short sessions too often, especially when we are overloaded elsewhere. But this little lady was willing to work and has good potential (I wish that the MDs would take our advice and send her to rehab instead of SNF, but that's a different story). We took steps, we did FMC exercises, we did self-ROM, and we opened 4 of the easy level clothespins 2x each. Those closepins were difficult for both of us, but she felt the taste of success and showed decreased depressive behaviors, so that was good. When I came back for her afternoon session, she said to her visitors, "That's my therapist! She's going to get me better!" BIG SMILE. She'll get herself better, but I will take the compliment. :)

My 5 year old from the post on Failures was back yesterday with his mom. We worked on some activities to challenge his balance, which wasn't difficult since his center of gravity is in his head. We worked on the swing (he does have independent reciprocal swinging motion!) and eventually progressed to catching and throwing a ball while swinging. I made big goofy faces about how strong his throws were and he giggled and kept going instead of saying "I can't" which is his favorite word set.

And I've been doing some good work on projects the past 2 days. Raided the speech therapy room (we are currently -2.5 STs) and borrowed a stack of books to explore. Among my finds was the Adolescent Test Of Problem Solving, which will be used on my 13 y.o. coming in on Monday, and a book on communication problems w/ pediatric TBI. The big ticket item though was the manual and installation disks (floppys!) for communication board software. I made the IT guy come install it ASAP as we get calls fairly frequently for communication boards for people in the hospital. It will take some getting used to, as it was designed for Windows 3.1, but I hope to persevere soon! Apparently, you can download a free trial of their new software here.


Books books, they're good for your head

Continuing education money is a perk that you cannot expect at a job, but if you do have it, it is quite enjoyable! We are trying to use up a portion of this money before the budget is reevaluated so that we can keep this great perk for years to come. So, my great SPD course earlier in the year was gratis, and now, I'm getting some great books to add to my library. The only downside with buying educational materials w/o a course is that you get no credit from NBCOT or your state association for the hours you're trying to better yourself. Not that I know of, anyway.
Sharing Time!! (books linked to their stores)

Autism: A Comprehensive Occupational Therapy Approach
This book is a lesson on why you should not sell your textbooks. I had accidentally left this on my half.com inventory, and then I wound up working in peds. Seriously, you never know what you're going to do with life and those books do come in handy. (Being an AOTA member will save you mucho dolores on this one)

Teaching Motor Skills to Children with Cerebral Palsy
This book was written for parents and professionals, and was quite economical. It does have a PT focus, so there's more information about gross motor skills than any UE activity. It does have good pictures of stretching and I'm hoping to learn more about the general progression of kids w/ CP. Also, I am going to trade w/ my PT buddy to read her new book about treatment ideas for kids w/ Autism.

Stroke Rehabilitation: A function-based approach
This is a textbook, and upon my scanning of it today, it has lots of evidenced based reports and good ideas for OT stroke treatment. I find both stroke and SCI to be areas that I would love to know more about, and I do see a fair number of CVA pts nowadays. I don't want to focus all my work on peds, and I'm hoping that this will be a helpful resource.

Observations Based on Sensory Integration Theory
This video/manual set came highly recommended by Delanah Honaker when I went to her course on SPD. It was out of my price range when paying out of pocket, but this is what I think CE money is really for. Since I lack the luxary of a pediatric fieldwork experience, mentor, rubber wall to bounce ideas off of, I am hoping to get some good learning from this so that I can improve my practice and understand SI in practice better.



A couple of no-topic updates :)
- First off, I am adding new links to the right. I have some good links for parents that I have stumbled upon and some new Autism-related links.
- Secondly, I had some great talks recently with patients and family members about preventing occupational deprivation in the elderly. I am planning to make a handout to post on OT Advantage.
- Third, my husband has helped me conquer some occupational deprivation of my own, and took a day off work to pack cranky-morning-me off for an awesome canoeing trip. I used to spend my whole summer on the water, but OT school KILLED that, and it was great to get back to something I really love to do.
- And finally, I had several questions from Melody in an earlier post and I realized that I could shed some more light on my situation.
Just wondering about two things outs of curiosity. 1. do you work in a school based/clinic/hospital setting? and 2. How do you feel working with children when you have child/ren of your own?
I'm considering either peds or acute physical when I'm graduating but Im planning a family as well and my mum rechons working with adults would be more of a relief.
Whats it like for you.

PS do you teach sign language?
1. I work in a small hospital which houses a SNF floor and several acute care floors, with a freestanding outpatient clinic where I see the pediatrics. I have a handful of OT/OTA coworkers.

2. I do NOT have kids. (This is actually a sore subject when asked in person, as a patient or a coworker speculates at least 1x/week that I am pregnant. No hard feelings for the online ask, but people who see me in person should note the complete lack of baby bump.) Actually, after my first neuro class in OT school, I don't know that I could make it through a pregnancy, as I am incredibly predisposed to worrying over everything. I am involved with activities that are typically reserved for parents (girl scouts, VBS), but it is because I believe in spending the extra time I have trying to give back now and then to organizations that were meaningful to me.

2b. As for the job I will have when/if I have kids, it's hard to say, as my goals for the near future aren't so clear. Adult rehab can be very physically exhausting, and a salaried job can be exceptionally time consuming in the day to day. I know of a lot of therapists who got into school system practice to schedule more time with their own kids. There's advantages to both sides, but I'd say that what OT parents are really looking for in a job is: flexible hours and good insurance. By flex hours, I mean that you can take days off without giving lots of notice, get vacation time (especially if you get school holidays), and know that you won't be asked to work a lot of weekends. I could be wrong- anyone in this situation can comment with their real thoughts.

And 3. I don't teach ASL, though I did take a semester in college and worked with a child (in a non-OT way) on baby signs. I know some basics for working with my speech limited kids (colors, OT-related actions). I would love to be totally fluent or at least generally better, but there is no way to do so without a lot of time devoted to practice.