Holiday Bouncing

Well, things are getting busy as it gets near to Christmas time... The acute care are trying to clear out their floors so our SNF floor will be filling up even as we try to discharge all that those that can. (word to the wise- don't get an elective joint replacement a week before any holiday that you don't want to spend in the hospital. even 2 weeks.) I won't be seeing any pediatrics in the next 2 weeks, due to this resulting business and my own vacation, but I did advise everyone to keep their kids' schedules as normal as possible during the holidays to prevent the meltdowns. I have some things to figure out... like whether to add cranberries to the dressing, what everyone's addresses are now for cards, how to get the most gifts from Jingle in Animal Crossing, and how to best coordinate a visit to 8 locations in 10 days and still have time for laundry. So as a result, I will schedule some updates if I find the time, but if not, oh well.

Until such a time, I leave you with a tip... if you don't want to scare away your coworkers who have a limited understanding of sensory processing, sit on a regular boring chair for your lunch party.


OT WebGems- Brain Edition

OT WebGems charges on like a hybrid car rolling downhill! Ok, "brain" is a pretty broad term for an edition. The following links are mostly CVA related, with some NON-controversial information on stem cell research, and a couple of other thinly related articles. Who doesn't like neuro-know-how? Onward!

TIA Diagnosis- Neurologists have found 3 indicators to help avoid misdiagnose TIA. Briefly, if the person has had a slow onset of symptoms, vague symptoms (w/ or w/o neurological symptoms) and/or if a TIA had previously been ruled out at another time, then it is not likely a TIA. We do get therapy orders for pts w/ TIA, though they sometimes turn into a 'walky-talky' (as the speech therapist calls it) before we get there. I did get eval orders on a person who I had discharged on eval the previous day as she continued to have neuro events while in the hospital.

Stroke Centers- This study found that pts who received care at a specialized stroke center recovered better and stayed better than those who had care at a non-specialized hospital. They recommend telecommunication for rural hospitals, but I wonder if they explored the SES factors of their participants, as there can be some major overall health differences between city-dwellers & others who can get to a specialized center and those who are in a more rural environment.

Brain Implants- Scientists have found that there is some same-sided brain control over body movements, and are using brain-computer interfaces to help overcome hemiparesis. They can't leave the implants in long-term though... yet. Also, if you have not yet looked at BrainGate, you should definitely check into it. One of my classmates found this in late 2006, and they have continued to improve their research and tests.

Reprogramming Adults' Cells- Scientists have now taken a fully developed adult cell and transformed it into a different type of cell. This isn't super-new, especially because one of my former fieldwork CIs had a pt who had an experimental procedure where stem cells were used from his nose to help him overcome a paralysis. But, very cool.

Google- This was an interesting article about brain scans done in older adults during web surfing, but I think they missed a discussion point. It was the web-savvy users who showed the greatest brain activity during surfing, which I would think means that people need to develop their 'brain-gain' activities early in life and continue them, or that you would get less benefit from starting one of those activities later in life and being less skilled at it. I'm not sure if that really fits with what we already know about brain development though.

Amnesia- I throw this in here as a short, less-scientific but good intro to neuro article addressing amnesia and whether one knows they have it or not. Just happened to come across it while writing this.

Body Snatchers!- Scientists were able to create an illusion of body swapping between a person and a mannequin, tricking the brain's sensory perceptions. A cool jumping off point for robotics, VR, and possibly sensory reeducation?


OT WebGems- Autism Signs Edition

To the thrill of readers everywhere, OT WebGems returns! Source material is currently plentiful, but connections and potential segues for these have been scarce. Here are a few pieces of current items on early autism signs and general diagnoses, plus a little celebrity tidbit on SPD.

Developmental Milestones: this is a comprehensive list of links for milestones for infancy to adolescence. Written in layman's terms with lots of extra resources.

Unusual Use of Toys
: a study looked at infants' toy use and then later followed up to see which children were diagnosed with autism. The children who were later diagnosed had a much higher tendency to rotate toys or look at them from the corner of the eye. The researchers noted that many parents noticed signs of autism before a diagnosis is made and are hoping to help develop better early screens.

Sound Processing: an MEG study found split second sound processing deficits in kids with autism compared to typically developing kids, which could be connected to the language issues seen.

Ok, this is a controversial piece. It had an equally controversial discussion, and the transcript to that is linked on the article's page. The author's son was diagnosed with autism at age 2 and they are now involved with a study about children who "emerged" from autism. It was an interesting read, but I think that the soundest words come at the end of the article from a researcher involved with a separate study and a member of Autism Speaks.
  • "I don't know that the children 'recovered,' though they did improve . . . to the extent that they no longer met the diagnostic criteria," Stone said. "Almost all continued to have some form of developmental disorder."

    "I think the most hopeful message we need to give parents," said Geraldine Dawson, chief science officer of the nonprofit group Autism Speaks, "is that all children with autism are capable of learning and developing new skills with the help of early intervention."

and, in mostly unrelated news, but mildly interesting nonetheless, Daniel Radcliffe (aka Harry Potter) is apparently now public about having dyspraxia, part of the SPD umbrella. The article is not particularly thoughtful about the hidden disability, but I found it to be an interesting tidbit.


Some Online Therapy Toys Shops

Do you have any money left in your budget as the year comes to a close? Here's some places you can throw it! Not an all-inclusive list, but this could certainly help fill your clinic or playroom while stimulating the economy.

SPD Foundation has now opened a store where you can find different sensory products. The fine motor and social sections are rather bare, but the store is new so I imagine they will grow in the coming days. They also have free shipping on orders over $50 until 12/31/08.

Fun and Function is a store owned by an OT trying to provide affordable pediatric therapy toys. They have an "
exclusive line of scooters and portable writing kits" which look pretty cool. The site is very well organized and has a lot of tools for social skills under the "resources" section. And if you like the clock timers that show the disappearing time... check out the wristwtach.

Pocket Full of Therapy has been around longer and is also OT owned. They have a good selection and there's not a lot of repeats between their categories. I can't link to specific items, but there's a lot of books that I'll be considering when I (hopefully) have fresh continuing ed money. There are also hidden holiday word scrambles that can earn you an extra gift at checkout.

Hammacher Schlemmer claims to 'offer the best, the only, and the unexpected.' I love this tilt board with modes to match sound/color/number, remember a sequence, or make a freestyle song. Cheaper than a WiiFit! I also like the Hide 'N Seek Monkey, and the ever-so-cute Constellation Turtle.

Small successes

My posts that can be labeled under 'inspiration' have been pretty lacking, which is probably an outlook thing. But here are 3 great small successes from pediatric land this week, plus a small SNF story thrown in. And though they are small victories, it's more than we often get.

Little Miss X is someone I've known for awhile. She is about 8, has autism, and has recently started ABA therapy at home, also on a new special diet, and they're making some great changes at school. I cotreat w/ PT and we have recently had some success with using patterns for different actions. This has really helped her with doff/donning shoes, she really loved the "monster under the bed" toy and really understood how to retrieve the object and then reinsert it under the pillow. We have worked on throw & catch for months upon months, and yet miss S would become distracted, just flip the ball out of her hands instead of throwing it accurately. I don't know what it was about Tuesday, because we have used the "ready, set, go (throw whether ready or not)" method with her before, but this time it really worked. Even when she wouldn't put out 'catching hands' ahead of time, she would bring her hands together in time to catch the ball. We worked up to 10 rapid catch/throws with no drops and accurate throws.

Little Miss Y has also been a long term client. She is 10, has CP, and has just restarted therapy recently due to an orthopedic surgery. Her mom has more focused goals now relating to her ADL performance and overall function. Her RUE is often held in elbow extension, extreme pronation, wrist flexion, and finger flexion. This has been a challenge for me in the past when trying to help her stretch or get in a more normalized position for an activity. But at this point, I just want her to use the RUE in a semi-functional assistive fashion. So we have worked on pushing objects across a table or holding them using the dorsal side of hand & wrist. We have also started a very very modified CIMT program where a thick sock is applied to the LUE, which she hasn't actually started to hate yet. At any rate, this week, when she was pushing these oversized jacks, I noticed that her thumb was more separated from the rest of her fingers for a change. So with a lot of coaching, she was able to basically drive her hand over the jack and manage to get one stick beside her thumb, and then get enough thumb adduction to actually pick up the jack independently! Previously, the only way I could get her to hold an object w/ RUE only was after placement, but she picked up 6 jacks and transported them across midline. Only assist was for wrist flexion to stimulate release.

Little Mr. Z is the third of the long-time peds clients. We are working on developmental skill progression. We have tried a lot of BUE activity, grasp & release, purposeful use of UEs. He's nonverbal, so we anytime we can get a smile basically makes a great day. This Monday, we were working on BUE coordinated use of toys using this accordion that I found in our closet. With PT on one arm and me on the other, we pushed and pulled and made the accordion make funny little sounds and Z just laughed and laughed.

I love the little smile moments, I love having something to tell the parent how wonderful their child did. Sometimes it's hard to feel that progress is happening, especially when therapy has been continually ongoing. Heck, my BKA pt. on the SNF floor couldn't even see her own progress over the past 2 weeks when she used to be a DEP Ax3 for supine to sit and now is SBA. She was also able to don pants in bed using semi-SCI method, and transferred to a chair for the first time using a sliding board and 2-3 person assist. At any rate, we all need to feel and share the successes when we can, since the lack of progress can be so disappointing. Parents, therapists, patients... we all need an uplifting moment to get through the day.


People Say the Darndest Things

A glimpse at some of the awful things pts have said lately that we have laughed over.

A mother was observing me in my second session with her child. She said, "Do you have to have any special training to do this?" I replied, a little icily, "Yes, I have a masters degree." Then her motive became clear when she said, "Oh... do you need an assistant?"

Our COTA gave the Mini-Mental to a man who is in early dementia but responds well when given extra time. His sentence: "I don't trust you."

We were getting ready to evaluate an elderly lady with compression fractures and she is making some pained faces as she gets out of bed. Then she says, "Don't mind me, I just bitch a lot."

I was going over the home safety cards w/ a pt. with considerable problem solving deficits. I showed him a card of a man having a grease fire on his stove, and said "This guy has a problem." He responds, "Yeah, he does. He's black."

Female PT and aide walk into a man's room and try to get him to take a walk. Man looks at the PT and says, "I'm not going anywhere with you, fatso." Aide goes, "who are you calling fatso?!" and man says "Her! [the PT]" As some background, this PT is probably the most 'in shape' person on the staff. Aide couldn't stop laughing for ten minutes!

Same PT is starting a fitness consulting business and wearing buttons with catchy slogans to advertise. I did a double take when I read her button... I thought it said "Decide, Commit Suicide." It actually says "Decide, Commit, Succeed" but my terrified expression became the laughing point of the day.

A man I am working with is struggling to get out of bed. He looks at my nametag and says, "occupational therapist... is that another term for sadist?"


Touching Moments

Every now and then a pt. says something so cute, personal, or touching that it just tugs at the heartstrings... here are a few.

I have a pt. now who has Parkinson's Disease. She has a 3 story house with the only bathroom on the third floor. Her husband of 57 years carries the BSC up and down the stairs every morning and night for her.

A 12 y.o. w/ Osteogenesis Imperfecta is receiving PT. He had a recent fracture and told his PT, "I was doing so good... I made it all summer without breaking anything!"

In a family meeting, an elderly man's children were trying to get him to adopt some safety measures, including not going up and down the steps. He likes to meet his Meals on Wheels deliverers at their car, and when it was suggested that they could bring the meals in, he said, "but some of them are in bad shape!" He also likes to use the steps to sit outside and feed his squirrels, which he has been doing daily for 45 years. When his family tried to say that they only wanted to make changes that would be helpful for him, he said, "how can I trust that you'll do that when none of you even feed my squirrels? They watch me eat breakfast by sitting on the skylight and will eat out of the palm of my hand, and none of you even put a tray out for them!" This man has such a deep affection for his woodland friends, even used to feed them with his now-deceased wife. It was really touching, but sad since he was obviously upset about the care the squirrels had received. He went home last week, so hopefully things worked out well for him.

In other news, I have had 3 work related dreams in the last week... not cool. Don't need to carry the stress home.