Photo Phriday- Pre-Christmas Edition

A very thinly tied together theme post, but might be the last until after the holidays. In fact, I've actually had calls for evals pouring in since I got back in the country, so January is looking very busy already! Some of these pictures are just placeholders for thoughts that came up in the most recent #occhat but hopefully you can indulge me and my holiday thoughts.


This is Swedish Santa Claus! I had a great time in Sweden once I got caught up in the right time zone. Wish that I could have stayed longer and that it could have been summertime. If you're ever looking for a foreign country to visit and don't speak any language but English, Sweden is a  great place to go.


Our Swedish friends had some requests for US gifts that were kind of amusing. We packed a suitcase with Disney Cars, junk food, and pajamas for their kids.


If Miss Awesomeness went to Sweden, these would have come home in her suitcase. Best pencils ever.


So the #occhat was on Christmas traditions and how we take part in them. I shared a few, such as shopping for an Angel Tree child, and my mom taking poorly focused pictures of each present we open. Some of our traditions have faded away... we used to go to my great grandma's house every Christmas Eve and the drive always used to feel like forever (probably about 45 minutes). GG moved into town in her final years and when she died the tradition died as well...I have no idea what that side of the family does now, if anything. I love hanging up our Christmas cards and setting up our WVU themed tree.

We definitely have our share of off-beat traditions. My brother and I love watching Home Alone at Thanksgiving and though we can't watch together anymore, when it comes on TV we always text lines to one another. My Grandma has had us all listen to an Adam Sandler CD I got her for Christmas one year- much to the chagrin of my mother who hates it. As a family, we spend our holiday break watching all the football bowl games and seeing who will win the holiday pool by picking the most games correctly. The oddest of our odd traditions may be the "mandatory underwear" gift which always comes in a Victoria's Secret bag for the males in the family.


I would say that for the past 15 years or so, I have been the designated family gift wrapper. It's something that I find soothing (until you've done about 30 packages), though as you can see from the picture I'm not particularly good at (it's a craft, and I have an extremely poor track record with crafts). Fortunately, skill has never been a requirement, just a willingness to sit and do it.

It's the little things that make up traditions, occupations and routines that piece together to form our lives. I've been stressed about some big and little things, but it's nice to hold onto some of these little warm fuzzies when things are changing or not going as expected.

Back when Linda was organizing the World OT Day blog carnival, I just could not even get an entry on "balance" together because my life was so out of balance. This week I have been stressed and depressed about some of the things going on, but thinking about the little things has helped put it all back in perspective. When looking at "the big picture," my life is actually going very well. I had my 10 year HS reunion last summer and realized that I was about where I had thought I'd be when I graduated. I've done some cool OT things in my 5.5 years since graduation, and though I can't necessarily say it was "according to plan," since I've had many plans, I've still accomplished things that I did not expect. Life has come into place for me in a lot of ways, and I've really been letting one out-of-balance thing (my career) dominate how I view my overall balance.

It's been difficult for me, because there is a large part of my identity that is wrapped up in being an OT. (One who is hopefully growing into excellence) And not having a typical job or regular hours or secured employment has been really hard for me to adjust to. But this is where my life is right now, and overall it's a very good place. I've been focusing on the career, and what is not there, for a long time. But there are a lot of other great things going on, and it's time to take a breath and make a shift in focus.



We end with a teaser... in addition to the wrapped presents I just have these piles of OT goodies getting ready for my 5 year blogiversary giveaway!! Great stuff there from AOTA and Maddak and more to come. I am really looking forward to the celebration and I'm hoping that readers will as well.

Adventures in Scheduling

With all the crazy scheduling that is required as a therapist, you'd think they'd make you do logic puzzles as part of an entrance exam. Here are a few general thoughts on the mishaps inherent to scheduling. (this is a bit scattered since I'm still jet-lagged, so please forgive any dangling modifiers or unresolved thoughts)

First off, I think that there is this cultural norm of what a "workday" entails. If your parents worked non-medical white-collar jobs then you can probably identify with a 9-5 workday as we see in so many shows and movies (at least those that actually indicate that people WORK for a living, as opposed to being independently wealthy enough to just sit around and talk). Even in college, actual "working" time for me did not get up to 40 hours/week until the end of OT school (at which point we raced right on past 40 and never looked back). I know that there's tons of people out there doing simultaneous job and college, or 2 jobs regularly, all I can say is more power to you. But I had this expectation that a "normal job" would have normal hours and that the schedule would not be that bad.
I have realized that was complete BS.

This enlightenment took its time coming. On my phys/dys fieldworks, I had a hard time adjusting to a 7-330 schedule, especially with a nonexistent lunch that was dominated by meetings and paperwork. Despite that, people almost never left on time, needing to stay for one reason or another. It was frustrating as a student, waiting at the end of the day to get your notes signed and be told to have to redo them (now) when it was already past "quitting time." The woes of being a salaried employee- you will often work over the expected time.

Scheduling within your day is another insane proposition. In acute rehab, we had to work as a team to make sure (each day) that the client had their required time in all services, minimal time wasted sitting in the gym between services, at least one ADL per week, and so forth. In the hospital, coordinating cotreats was the biggest scheduling portion, and knowing that your whole day was likely to be derailed by patients going to tests and whatnot. The hazard of hospital work is ending up with a back-heavy day because not enough could get done in the morning. School scheduling had to work with the class schedule to make sure that they weren't being removed from important learning opportunities or special classes or being overbooked in a day. (We did pull-out services and I could not even conceive of how to schedule push-in during my year balancing so many different schools. I would love to hear experienced therapists' tips on that.) However good your schedule is, it is likely to get derailed by an IEP meeting or school assembly or lockdown drill. Outpatient scheduling might be assumed to be the easiest, but often you are dealing with people who need to be seen outside of their own working hours or school hours, so fitting in times can be tough.

I'm great at logic puzzles, but daily scheduling is a monumental frustration to me. One of the few beauties of being a prn employee is that I can just show up and do what is already assigned... and if the patient needs to schedule for their next time, I usually turf that to someone else.

Good coworkers will also adjust their schedules to help one another, even if it means balancing inpatient and outpatient work in the same day, or taking something difficult. But that is another thing that will wreck your schedule... and productivity if you have to track that.

My most common work now is as an independent EI contractor. I'm still trying to get into a good groove for getting the kids scheduled out right. Part of me doesn't want to over-analyze it because I don't have a huge caseload (yet?) or time demand, but my left brain would love to just have regular times for each kid each month. Evals have to be scheduled within 15 days of hearing about them, which is not really a lot of time to work people in if you do have a lot of other engagements... like holidays, which we have a few coming up.

Holidays are a whole issue all their own. Remember getting days off in school for holidays? And long Christmas breaks? That does tend to go out the window. Hospital and SNF people have to rotate through holiday coverage... when you start out, especially if you're young and childless, expect to work some of the biggies. I remember a boss telling me when I was interviewing that they paid so well for big holiday coverage (it was good- effectively 3x normal pay plus a PTO day to be used later) that they never had to force people to work major holidays. 6 months later, when those of us who were under 30 were all sitting there on Christmas day, I found those words to be particularly irritating.

Another fieldwork instructor would be laughing at the turn my life has taken. She had her own business, and I remember being aghast when told that we would be working on a major holiday. To student-me, I could not even conceptualize why you would be working on a national holiday. Well, now that I am mostly self-employed, I get it. I just scheduled a kid on a major holiday without even thinking twice. Major reasoning- I no longer get paid to take holidays... or paid regularly at all. If I have a "day off," it's just another day making no money whatsoever, and I've had plenty of those days for awhile. 

Now with my EI kids I would like to schedule multiple visits in a day in a geographically sensible way, but it hasn't worked well yet. If I do a community outing, it's hard to say exactly how much time that will take, so planning the next visit can be tricky. Accounting for travel time is hard sometimes as well. But there's just the general Murphy's Law that comes into effect here also: the people who live near each other will have opposing personal requests, one will want morning and another will want evening; one can only do Thursdays and another Tuesdays; everyone will want 10am; on and on it goes.

Is there a moral to these scheduling woes? (is there anything logical written by someone whose personal time changes have zapped her ability to do anything but stare like a zombie?) I guess the overriding theme would be that you have to be flexible. No matter how nicely laid out your schedule is, it is likely that it could all go to pot anyway. No matter your personal preferences for workdays, if you want to get paid and your employer decides you're working weekends or holidays, that's what will happen. Until you go into business for yourself, and then you'll probably work those days anyway. And if you like the freedom of "set your own schedule" prn work, it's probably good if you have a backup income and a good budget. 

Photo Phriday- My Office(s)

So right now my work life is mainly Early Intervention as an independent contractor and prn work at a local hospital/outpatient center. It's a primarily self-employed, no-guarantees type of existence. Work gets done but much more differently than when I had a predictable schedule and landing zone. So here's a peek at the many offices of Cheryl.

I took this at the desk I was borrowing at the hospital. Depending on my schedule, sometimes I will stop in during the day or clock out and continue to enjoy a heated area to conduct business. (It's also nice to just be able to engage with people instead of hanging out alone!) I was able to borrow a printer, scissors, markers and glue to make these visual stimulation patterns for one of my kiddos. 

I bought these (rather expensive) stamps when I thought there was a hope of getting back in the schools this year. The kids loved stamping their attendance sheets and I thought these would be a superb treat for them. These sit on my computer desk at home which only gets used when I have to type an eval or print something. Unfortunately there just haven't been many opportunities to use these and it seems a little self-aggrandizing to stamp a "terrific" on my own things. 

The mobile office- e.g. front seat of my car! I spend more time in my car than probably anywhere else. It's depressing. You can tell that it's very well used... pictured includes the typical wallet, coat, lunchbox and clip board. But there's also the cat toys for multisensory play, straws and applesauce for sensory sucking, and a Child Guide magazine buried in there.

Here I am in my most used spot on the living room floor, making some weighted objects for the kiddos using beans and a pair of girls' tights. In retrospect, I definitely should have thrown a pantyhose in there before the beans and maybe double socked, but they should serve their purpose and I needed to be quick. Cameo appearance by my trusty lapdesk, holding the lappy I most often use. Working wear is what you make it... including Halloween shirts in November and sweat pants from high school.

Speaking of working wear, this lab coat has been hiding in my closet since 2006. You can still see the original folds from the factory! I wore it for the pinning ceremony, used it to store a couple of pins I probably would have lost by now, but otherwise have not even thought of wearing it once. It's also not even close to being the correct size so I am not sure it would look professional if I actually did put it on. Does anyone else have a hiding coat? Or are there mythical people at top of the line facilities that wear them and aren't constantly confused with doctors? I would be interested to know.

#10minTues : Facebook privacy

It's Tuesday! Went to bed late but haven't been able to sleep since 5am! This afternoon is going to be unpleasant!

 Figured I would get my entry done now because I'm pretty sure that I will crash this evening. It's been a very busy time lately and only getting busier. I thought I would have this week to finish some EI visits, get the house clean, and pack for our trip- but when I get prn calls and calls for new evals, I can't very well turn them away, so what was already a busy week is now a PACKED week.

 I'm working on contacting companies to get donations for cool Blogiversary giveaways in January, which would obviously be easier if I had a little more down time but I think it will get done. Looking for apps, small items, coupons. I was hoping to be able to do an entry or two on "my favorite things" but I think I have expensive tastes! Example- my grandma loves her HandyBar, which I got for $10 at #aota12, but they sell for $25 and up online.

 Main topic today: Facebook, and social media use in general. My buddy Erik, aka @armyOTguy will tell you to be active on social media as an OT practitioner and to be consciously promoting a personal brand. That is a good thing to do, and could be effective marketing for both you and the profession. However, based on my own personal experience and my Facebook newsfeed, I would not advise that. Students are educated on HIPAA and privacy to the point of getting glazed over whenever it's mentioned. But it would appear that despite that, it takes social media users some time of trial and error to really figure out where that boundary is- it's usually more restrictive than they think. Similarly, students are educated on professionalism and professional behaviors, but may not be prepared to apply those to an abstract social media setting. 

Personally, I kept a blog intermittently during college. It faded during OT school because I was locked in the health sciences building for 40 hours a week. But I know that there were times when I was aggravated with a class or concept or group project and had a post that was probably less than professional regarding OT or the program. We didn't get Facebook at my school until I was already in OT school for awhile, so we didn't have too many problems there, but did have a tongue-in-cheek OT facebook group that probably wouldn't have gone over well with the administration. And we definitely had people who replied-all on the listserv and got in serious trouble for one reason or another.

 As surprising as it could be, there were several of us in our small class who had contact with "local celebrities" (for lack of a better word) and I think that the fact that we weren't yet immersed in social media culture played a factor in keeping each person out of privacy violations and associated trouble.

 That was my (ever aging) experience. Now I have some Facebook friends who are OT students (usually because they were my friends before they went into OT school, I don't have a crazy Facebook following). And sometimes it is cringe-worthy to see their updates about school. Even something that may seem benign to you may not be so construed by your program, future employer, classmates. Examples (straight from my feed, mind you!) include: calling professors clueless; saying portions of your program are useless; fieldwork complaints; patient descriptions; assignment gripes; various program criticisms... you get the drift. None of these were terrible glaring violations ("I think Mrs Smith in room 33 has the ugliest scar evar!") but they do not promote a positive image of the poster or the profession. These are not from clueless people, but just people who don't have a good understanding of professional representation yet. It (should) come with time.

 I reiterate- it should come with time. Having a job and a license increases many peoples' sense of responsibility for their actions. But my suggestion to you is to take steps to be extra careful.

•  First of all, don't post things that you aren't OK with every person in the world reading. Mom, dad, program director, dean of admissions, fieldwork CI, future employer, and the patient themselves. 
• Remember that it is not all about you. Each person (including the patient!!) is entitled to their story. Just because you would be ok with someone sharing your story if the situations were reversed does not give you permission to post theirs.
• Thinking and delaying before posting to twitter or facebook will probably help you self-censor. Things that seem fine in the heat of the moment may not seem so later in the day after you've had some time to consider.
• Button down your privacy settings. There are times when I turn off the ability for people to even search for my existence on Facebook. (clearly, I have a social media presence, but I try to keep personal and professional separate on a few platforms)

So that's my soapbox. I welcome other peoples' opinions on these issues, but my personal recommendation is to err on the side of caution to avoid issues down the line. Time's up! a lot closer to 30 minutes than 10... 

10 Minute Tuesday- Intro and cell phones

I am going to start my new feature, which may dribble a bit in the holiday time but I want to make it regular in 2013. This involves me writing for 10 minutes and topic switches are permitted- anything to get the post written!

Obviously I missed getting this done on Tuesday but I essentially worked 13.5 hours and was nothing short of exhausted. Did inpatient hospital in the morning, outpatient in the afternoon, and an early intervention client late that evening. It's funny to see sensory overload sometimes, I came home and my husband wanted to talk to me about a video he was watching at the same time that there was something on the TV and I just had to tell him to choose. I could not possibly focus on all that when all I really wanted to do was get in a fetal position and sleep for 20 hours.

Sad that I missed today's #occhat which appears to be on adaptive equipment use and practices when issuing equipment. I have lots of thoughts on that and have posted before, may need to do another after reading their grabchat. I also have interesting really old-school AE pictures from when my mom was in school to do voc rehab. It's neat to me to see how people used to make certain things, and some of them have completely gone out of vogue but would still be useful. The copyrights are expired on most of them so I will have to scan in some pictures if people are interested.

OK my main topic was going to be cell phones, and how essential they really are in today's world and especially my OT practice. I seriously cannot imagine doing my early intervention job without my phone. For today' client alone, I was able to do the following:

- text to confirm the appointment before driving there

- access my master file of client names and addresses

- get directions and navigation from an unfamiliar starting point

- show an app that would be helpful to the family's goals

Seriously, without my phone, I would have had to use my rolodex to get their number,  just leave a message on their machine and hope they'd be home when I got there, have to add in an extra 25+ minutes to get back on my familiar route, and spend a lot of time making equipment by hand. I have also used my phone to show a picture of a toy that would be helpful, and in the school system it was so crucial to get a picture of hand function for the evaluation. That's barely scratching the surface of what it is capable of, but I really couldn't do without it in practice.

Time's up! Hope you enjoyed this post and that I'll be able to keep up the pattern.

What's up Wednesday?

Not a lot of time to write, but I want to get a couple of ideas down.
I'm kinda ready to jump to January and start some New Year's resolutions personally and professionally. I wouldn't necessarily hold for the traditional start at the beginning of the year, but life is HOPPING for us right through the end of 2012. My early intervention caseload is really taking off (hooray increasingly regular employment!) and with the holidays the hospital and outpatient center have been calling me in for more prn work. Great, but really busy! I'm trying to get some artwork done for friends for Christmas, which is challenging from a double standpoint- deadline and lack of artistic talent! Holidays for us always means lots of traveling to see family and friends, but my husband will also have to potentially work during our normal holiday time so that they have a product by year's end. And if that's not enough- we have a trip to Sweden coming up in the middle of all that.

So life is really busy. Not sure how I'm going to get all my visits in... I'm suspected a lot of make ups in January. I am trying to snap out of my previous blog funk and think it's been going ok. I plan to implement 2 new changes for blogging. One is to assume that ideas are rotten after 2 weeks. I may extend that deadline out a little bit, but I need to take quicker action, write what I think, and be done with it instead of ruminating over the details as much. I get very frustrated with myself when I see that someone else has acted on an idea I had, and it happens much too frequently for my taste. To enable this is change #2, I am going to try to do at least one 10 minute post per week. I'm going to allow myself to jump topics within it and let it be a little more stream of consciousness if needed, a'la Awesomeness.

My 5-year blogging anniversary is coming up in 2013 and I am excited! I just realized that this morning. I want to allow myself some celebration around that. I am planning a feature on the blog's Greatest Hits... I am proud of some of the writing that I do, but it seems to me that the best writing gets the least attention, so I'm going to put some of that out there. There should also be a giveaway, so I'll have to take some time to think of something appropriately celebratory. And I think there will be some big news to announce during that time as well.

I'm going to take that excitement and help channel it into today- because I am going to need it! Crummy night's sleep where I should have gotten up at 4am, eval to write, doctor appointment, and late night EI visit with an hour drive there/back. Gogo gadget excitement!

Trauma Awareness for the Infant/Toddler Population

I recently attended our state conference and there was a standout session by Marcella Jacobs of the Kennedy Krieger Institute on OT and Trauma Training for Infants and Toddlers. It was very informative and thought provoking, so I've decided to share some of the things that I learned from that session. Warning, there are some sad references in this post, because of the types of trauma that infants and toddlers incur.

First off, she brought up a point that maybe some will find as common knowledge but I think is important to reiterate. If you move into a specialized OT role (though we all interact with children of trauma, knowingly or not), or a position that is not traditionally filled by an OT, you are going to have to look outside the OT CE box to learn new and relevant things. So to become a trauma-aware OT practitioner, she looked to courses offered mainly to psychologists and other groups that would apply to her OT life. Something to think about when planning your professional development.

As someone who has spent so much time in the phys-dys hospital world, "trauma" usually means multiple orthopedic injuries with potential (possibly undiagnosed) neuro injuries. Obviously, this isn't the same in pediatrics. Trauma to an infant or toddler can be any experience(s) that cause continued autonomic nervous system activation which changes the chemistry and constructs of the developing brain. So while that can be physical, such as shaken baby syndrome, it can also be chemical, such as prenatal drug use, or emotional, in the case of abuse. Other potential causes of trauma include neglect, hospitalization, or disaster. Being placed in foster care and having a continual rotation of caregivers and "siblings" can also be traumatic.

Brain scans show that compared to a person who did not have a traumatic experience, a person s/p trauma may have less activity in the fronto-temporal regions. This includes a less active parietal lobe which can lead to decreased speech. Occipital lobe activity is increased, which is sometimes seen in a child's hypervigilance.

Children with disabilities are at an increased rate for abuse and neglect, so it is likely that OTs will encounter children who have gone through or are going through a traumatic situation. I remember an upper-elem student that I worked with who was very verbal about the effect that his disability had on his family life- his deep sadness at not having his parents around was continually heartbreaking to me. And truthfully, if you are worried that your parent might not come back for their next scheduled visit or whether a complication of a condition you barely understand will land you in the hospital tomorrow, how can you really be ready to learn and grow?

I had not heard of the term "PURPLE crying" before, let alone knew that it was a normal baby phase. But when this was discussed it was clear that this would be a time when abuse would increase. Personally, this was incredibly intimidating and terrifying to me as a person who does not have children yet, but by having the information, new parents are more prepared for this time period. The aftereffects of shaken baby syndrome are just horrendous... I may never forget the faces of the toddlers and older school children I saw who had survived, and the EI team was absolutely inconsolable after a child died from this.


I had also not heard of the ACE study, which looks at the effect of 'adverse childhood experiences.' The ACE score is from 0-10 and measures exposure to traumatic experiences in the first 18 years of a person's life. There are multiple studies that have shown an increased risk for adverse health behaviors (smoking, drugs, alcohol use), heart disease, suicide attempts, development of depression, cognitive impairment, and early death. Again, these questions make me think of the kids I saw in the school system some of whom had such varied awful life experiences.


There are numerous signs/symptoms of trauma in infants and toddlers. Withdrawal can be common, and OTs may also notice decreased purposeful play, sensory processing differences, and uneven development/splinter skills. There are many invisible symptoms as well which have major effects in a child's life. This includes decreased growth hormone, decreased development of mirror neurons, decreased brain size and development, and decreased serotonin.

OK, this has been intensely depressing so far to write up. And it may have been that way for you to read. If you've made it this far, you deserve a reward, and if it's been making you sad you may need to inflate those endorphins through exercise or finding a way to think happy thoughts. (chocolate? cat videos?) Not trying to make light of the situation, but having ways to deal with the stress you're exposed to as an OT is imperative to prevent burnout. I think that this was one of the reasons that I couldn't tolerate ICU rotations well.

Finally, the good stuff! Some treatment ideas! These are more directly from the presentation but I am going to share them because I think that it is a difficult resource to get. The CDC states that the most effective treatment model for infants and toddlers is to promote parent/child attachment. This is directly in line with the early intervention model of empowering parents to improve their child's development. Research shows that music followed by tactile input is the most effective treatment. Ms Jacobs recommended using both a sensory integrative and trauma informed treatment approach. Helpful tips included making sure to decrease the stress response before doing anything else; being mindful of your own nonverbal cues including eye contact and touching; avoiding teasing and sarcasm; and being consistent and kind.

Parents, definitely consult with your therapist before trying any treatments, anything listed here is considered to be tried at your own risk. I have listed some suggestions that were offered by Ms Jacobs.
Gentle tactile stimulation through grooming and play
Calming music (Vibrational healing sounds were suggested) and performing typical preschool songs with motions
Swaddling and infant massage (if you are trained)
Cooperative games between child and parent- ball games, rapper snappers
Consider deep pressure activities such as weighted blanket or body glove with both parent and child (again, only with therapist supervision! Don't put weights on your kid!)

It's horrible that any child is exposed to trauma, but with proper training and intervention, there is a way for OT to make a difference to these families.

This was a terrific presentation and I'm happy to be able to share some of Ms Jacobs' awesome insights with you.

Further Resources:
National Child Traumatic Stress Network: tons of great resources especially for those in schools
CDC resources on Child Maltreatment
Child Trauma Academy: has free online trainings
You can also email the presenter Marcella Jacobs if you have direct questions

Thought from Spaghetti- Ask questions!

I was making spaghetti the other day and it brought back thoughts of activity analysis and fieldwork that I thought I would share. 

I remember my very first Level 1 fieldwork instructor being worried that I didn't ask enough questions. I'm a shy person by nature and also tend to think on things for awhile before asking questions so I see if I can figure it out on my own. It took me a long time to see her point, but asking questions is essential in OT.

If I was in rehab, and engaged in a cooking task (not hard to imagine that being an activity) it would be an interesting experience. A lot of my "cooking" is actually "microwaving" or "putting frozen meal in skillet." Not something I'm proud of but it is where I am right now. When I think of a meal that I actually make, spaghetti is pretty frequently it. But a lack of questions on the part of our imaginary therapist could yield a very different experience than I intended.

If a therapist didn't ask many questions after learning that I wanted to make spaghetti, they would still probably feel like they knew how to accomplish that goal. Buy some spaghetti noodles, a jar of sauce, bingo bango there's your meal, there's your occupation-based activity, your patient is rehabilitated. But I would be so unhappy if someone thought that was how I would make spaghetti at home, how I would want to continue making spaghetti. That is someone's idea of spaghetti, but it is certainly not mine.

If they did ask questions, they'd learn that I don't really want spaghetti noodles- I say "spaghetti" but usually mean rotini (springies) or penne. And I want to take the sauce and paste and spices and mix my own sauce. I need sugar, garlic powder, onion powder, and maybe oregano. I don't want to measure anything except with my eyes and hands. I need to be able to stand there and mix it all up with my spoon. Ideally, I'd make it with meat but that's become an issue of late (e.g. since 1996). I don't do raw meat if I can avoid it, and I've gotten pretty good about avoiding it. After all this, I need to be able to shake the parmesean cheese to get the lumps out, and pig out on my favorite meal. 

Why do I want to do it that way? It was the way my mother did, the way I learned to do it, and the way I want to keep doing it. By asking questions, someone could figure that out. So be sure to ask, ask ask. 

Here's some good ones you may want to try. The follow up is as important as the initial. 

What is your main goal that you'd like to accomplish through therapy? What does that look like?

How are things going now? What makes the situation better?

What have you already tried? Are you willing to change the task by trying ... ? What is essential not to change?

The Presidential Election and the Effect on Healthcare

I normally don't do this. Even with people I speak with in person, I don't get very political. Partly due to the effects of being a blue dot in a red state, partly out of actual politeness and avoiding arguments, and partly because I don't think that most political discourse has an effect on how people actually vote. But as should be obvious from the title and the disclaimer thus far, I'm going to go there today. You have been warned. (as always, I'm sure that my employers -such as they are- and state associations that I am a member of have no voice in what I write, and the views are purely my own)

My father is an economist/history teacher and political discussions were the norm in our household from a young age forward. I now spend a good deal of time interfacing with our state lobbyist regarding how we can best protect and promote OT in my role as VP of Advocacy. I am a registered Democrat, but would more accurately describe myself as a political cynic. I think yard signs should be banned for anyone running for a higher office than the state legislature. I think that the debates should be abolished since they only serve as moments to spit out talking points, cherry picked statistics, and are altogether worthless until you see the Fact-Check. I get super irritated watching both candidates move closer to the center as election day nears and simultaneously knowing that a third-party candidate has no chance at all in going far enough to keep the other two honest. Don't even get me started on the rights of a SuperPAC.

So I pay attention to things. And I have to say that I'm disappointed in the campaign so far from both sides. Obviously the negativity does not make for optimal TV viewing (all hail Netflix and DVR!) but even from a purely strategic point of view I think that both have made serious errors. The campaigns have chosen to push  repeatedly on little buttons when they had larger ones at their disposal. And from the ads in my region, you'd think the entire election was about abortion, and nothing else. I hate hearing how "this is the most important election of all time" or "this election will change the course of history" or "we couldn't last four years with X". It's all ridiculous, and a lie.

But there are still legitimate topics that will realistically concern people in the coming years. Healthcare should be of large concern for everyone, since it is a service that everyone will eventually need to use, a funding source for many of us, and affects the quality of life for our families and clients. So knowing how the candidates intend to approach healthcare (and reform, because the cat is already out of the bag) is important.

You've heard what they say- "The (insert party here) is trying to destroy Medicare as we know it!" But both sides have proposed changes to how the healthcare system will work. I say system and not just Medicare because Medicare is the driving force behind how other insurances set their coverage and rates. And it's not fiscally solvent. As the baby boomers age, we will have a larger number of people to insure, who are living longer, and fewer workforce members (to both tax and charge higher commercial premiums)- this is a recipe for bankruptcy. Change is no longer optional.

Both campaigns have essentially proposed similar tactics, which shouldn't be surprising if you consider that the ACA was drawn around Romney's plan instituted in Massachusetts. However, they continue to parse words (vouchers! exchanges! Obamacare!) in attempt to make the differences seem more drastic. Both plans would allow you to take federal money to purchase insurance from a marketplace that offers the minimum Medicare/federally defined benefits. The ACA proposes to re-prioritize Medicare monies to start some of the funding for their tasks, and intends to cut costs long-term through preventative care and a board of advisers who propose strategies to cut costs without cutting benefits. There are some lofty goals, and it will be interesting to see how we simultaneously shift to prevention and wellness while cost-cutting. The Republican plan intends to make Medicare a pay-into contribution system, counts on competition to drive down costs, and the government pays a premium cost for any insurance and places overage costs onto the insured person. Unfortunately it becomes quite a gamble for the insured person if competition doesn't reduce costs sufficiently, since they wind up holding the bill, and remember that many Medicare beneficiaries are on a fixed income.

Both plans claim to reduce Medicare spending by the same amount. Neither method has been proven to work. Both plans rely on Medicare cuts- the Republicans intend to use that money for tax cuts and deficit reduction, while the Democratic plan uses that money to fund Medicaid. The word from the Republican camp was that Medicaid (like FEMA and other state-benefit programs) would need to become completely state funded without federal support. Being native to a dirt-poor state, I worry about the feasibility of making that happen without major cuts to an already strapped system.

This is what I think is important, and I base this upon the clients I have worked with over the years. So many of my families depend on Medicaid. If they do have insurance, many times one parent was effectively forced to stay in the same job for fear of not getting the child covered under a new plan due to having a preexisting condition. I have worked long enough to know that all it takes is one accident or completely unexpected health event (e.g. aneurysm, child's cancer,etc) to completely bankrupt a family with or without insurance. I believe in protecting the people who are most disadvantaged- children, the poor, the disabled, the elderly. So though there certainly isn't a perfect option at this point, no golden ticket to magic wonderful healthcare, my vote is to continue the ACA.

This is an important issue, and I would advise you to read more if it concerns you.  My sources:
Here's a rundown from Politifact on truthfulness of claims on healthcare.
This one is specifically on the ACA (Obamacare) and claims made by both sides.
and one more specifically on Medicare claims

Will Medicare as we know it change or persist?
What the Romney-Ryan and Obama Medicare plans have in common
Democrats vs Republicans: 2 approaches to Medicare

Photo Phriday: Mostly Cheap Kids Stuff

Welcome back, photo viewers! Since we last met, football season is in full swing, I've had an NBCOT trip to Chicago, and my EI work has been picking up a bit. Today's theme is about therapy-type things for kids. I loved my school job last year, and was so fortunate that they had tons of terrific supplies for us to use with the kids, but I know that in many places school system and EI therapists are going on their own dime. It's no secret that I outfitted my EI kit with items from yard sales, which can be a great resource but uneven in findings. Here are some items that I found that are either cheap or sparked cheap ideas.

OK, we lead with the big guns. This is the not cheap one. This toy is called "Q-Bitz" and is available from MindWare for $25. It reminds me of an IQ test... you flip your cubes to match a design on the card, racing a friend at the same time. I think this would have been too high level for my caseload, but it would probably be a great release for a child with high functioning autism and good visual skills. If you wanted to grade it down and keep a visual challenge, you could easily make 8 square cards with the given designs, take pictures of them, and have the kids match the cards to the pictures. 

Sometimes people think they have to spend big bucks to get worthwhile toys for their kids, and everything with the word 'baby' has a 20% markup. The popular version of the stacker now makes a sound with each ring inserted and sings a song when complete, but it can be financially prohibitive for some families or practitioners. But I found this pack of sorting size/shape toys at Big Lots for about $10. 

The cheapest source of ideas nowadays is that series of tubes, the internets. With the rise of homeschooling and internet sharing, some great resources have come to light. File Folder Fun is one such site designed for teachers to create compact stations. Our district had a big focus on early literacy, and so when that could be incorporated into OT sessions, all the better. Pictured here are Candy Cane Color Match, Snowman Compound Words, Spaceship Rhyming, and Sunflower Sight Words. Also pictured in the background are hidden pictures from Highlights- also free and a great visual search activity.

If it's a good learning toy and can fit in a baggie, it's that much better. More items from File Folder Fun here (pumpkin words or not; cupcake size sort; past or presents; rock shape match; broken hearts) along with popsicle stick puzzles and Mat Man parts. The trees are part of a sequencing activity and I copied that from a teacher resource magazine- many teachers have huge collections of these if you have free time to go through them. 

So this isn't kid-related necessarily... or is it? Just a helpful hint that if you're taking notes, it should probably be enough that you know what the heck you were talking about. I presume these are book pages, but what book? what subject? what year did I write this? Obviously it was a large and seemingly useful book, but no clue from there. cookbook? no clue. 

Photo Phriday- early a.m. style!

It's early and I can't sleep, which is becoming the new normal. So I thought maybe I'd swing by my neglected blog and put up some new entertainment. Blogger has so kindly moved into this new editing format... hopefully someday I will adjust to it. On with the photos that are truly random because it is just that early!

One of the things I do when I'm not sleeping is jigsaw puzzles. This one is hard anyway because it does not have my preferred style (lots of words and defined objects) but instead is a fall vista in WV. Clearly there was a small perceptual problem in assembly... glad to say it's been fixed now.

Went to a football game and saw this bus in the parking lot- seems like I should jump aboard!

Normally my spiral staircase looks awesome. Normally, it doesn't look like it will send you to your doom on a tile floor 15 feet below. We are not living in normalcy right now.

This was a sensory challenging snack to make and eat.  I sliced bananas (gross) and spread on peanut butter, yogurt, and nutella. Then I froze them. They are certainly tasty treats but your hands get disgusting when making or eating them.

That's all I have for you today and sorry, some of them are twitter repeats. Posts always decrease during football season and the holidays but I will have some more updates soon including info about how I've been doing in EI. Verdict after first post in new blogger format: picture editing much improved, everything else more difficult, toolbar getting cut off on my tiny screen. Not loving it.

Photo Phriday: Accessibility IRL

This week's photo pheme is about accessibility. The whole point of universal design is that one object can serve multiple people with varied abilities. So here are some examples of increased accessibility that I have lately seen in real life which I think are noteworthy.

I saw these toothbrushes at a friend's house. These are made by Radius and claim to be more ergonomic for reaching back teeth. The brushes come in right or left handed versions with a soft, large head. My friends are convinced that you only need to try them once to be hooked for life... there were 6 of these at the house.

My grandmother had an "accessible" hotel room when she came to visit recently. This included a doorbell, low step tub, and these nifty alternative to drapery pull cords. I liked it and was able to move with only gross arm movements.

This pill dispenser is named for Ease of use by the arthritis foundation. My grandmother found one like this in Walgreens and really likes using the push-button.

I follow the "One Man's Access" blog and he has a feature I featuring annoying/interesting/aggravating pictures of access. We saw this double doorway with stairs while on vacation, and while we were hoping it was just a terrible grammatical error, I had my husband take a picture just in case.

Acute Care Tricks

There are so many OTs in the Acute Care/Hospital setting, and yet sometimes it's as if we're the black sheep of the OT family. There's not a lot of OT research done in the field, we must work within the medical model, and turnover of patients and therapists is high. I remember when I was getting started, I borrowed books on PT in acute care to try to bridge some knowledge gaps and vowed that there should be more on the role of OT. (click through to continue)

After spending four years in the hospital system, I had made up a list of topics that were relevant to OT in acute care that weren't covered well in my textbooks and had decided to do a series of serious blog entries covering these topics. Of course, this was in my +50 hour work week and long commute days and just never got it started. That is about the time that I saw this book coming out, and while I was excited, I was also really depressed about not doing my series ahead of time, and I stopped writing on the topic for awhile. (I haven't been able to see the book yet, but based on the contents I think that it would be really good for people new to the acute care setting)

Anyway, that's a really long intro, but I wanted to share some of the off-book tips for acute care therapists (many of these would be relevant to physical therapists as well) that I've developed (or stolen from smarter people) over the past few years.

- learn to get good at manipulating equipment. If you don't know what it is, what it does, or what happens if it gets disconnected- ask and figure it out. A good nurse friend will come and disconnect IVs, foleys, and PEG tubes if they're able to per order. Ask people to show you how to pop the ICU monitors off the wall. Stack your O2 tank on the IV pole, hook a chest tube on a walker, pin loose drains to the patient's gown... possibilities are endless. Pay attention to what the good nurses and techs do and take a page from them.

- double up on everything. Think you need 2 washcloths for your ADL? Better bring 4. Because one will drop on the floor or get really dirty and you'll need another.

- Be creative with what you have. You can't carry a lot of items with you in acute care, so nothing can be a unitasker. A mitten (used to keep people from pulling wires) can be a ball, which is a good early purposeful activity in the ICU. Objects like a safety pin and comb can be good for fine motor and stereognosis testing.

- speaking of the ICU, if you are working with someone (particularly male) who isn't able to stay covered with a gown and is kicking the covers off, the sleeves of a gown can become leg holes to help keep some modesty.

- Try to make it easy for the next person who comes along. This is a list of things you should return to place before you leave the room. If your patient is anything less than 100% ambulatory, make sure the bed is right beside the chair. Don't leave all the cords tangled up in a corner. And if you can make the bed fresh (or even get the tech to help you during the tx) then it will very much be appreciated. When you're working with someone on their first day after an orthopedic surgery, or any time that you don't feel very confident that the person will actually make it to a chair, you need a different bed changing strategy. As a person is sitting EOB, (maybe as you're taking vitals or the PT is checking something) pull the four corners of the sheets off the bed. Then your helper can put the new fitted sheet and a folded draw sheet on as close to the patient. When your patient stands up, the helper pulls off the old and moves over the new stuff LICKETY SPLIT. Voila! new bed, ready for your person to collapse back onto if needed.

- In a pinch, the back of a sturdy chair can serve as a walker for standing. This usually ends up happening in the ICU when you weren't expecting a person to do any standing, but they surprise you in a good way. Not such a good way that they start cartwheeling across the room, but good enough to get a short stand in.

- lastly, there's one accessory you should never be without. Jumbo safety pins. Stick 10 of them on your lanyard or off your badge tag- they are so often useful.



What's the trick that makes your life in acute care easier?

Dipping a toe into twitter chat

While I was on vacation this summer, I was finally able to participate in my first #OTalk session via twitter. Because the brains behind this chat are in the UK, it's usually hard for me to join in due to work required at 3pm EST. But since I can't be outside most of the day while on vacay and the topic was about blogging, it was perfect timing to participate.

So, briefly, if you're not using twitter yet here's a few things you should know. Twitter is a microblogging service which allows you to post updates of 140 characters or less. By using a hashtag (# +designated word/s) you can connect with any other user also discussing the topic. You can use a service when participating in a twitter chat to make following the stream easier, or you can search within the basic twitter client. This was my first time in a twitter chat, and I was able to find this great introductory post to make it even easier.

I used TweetChat to easily follow the conversation and have it automatically add the proper hashtag for each tweet. It was easy to just log in with my twitter account and not have to setup anything extra. I was also able to bookmark the room for #otalk so I am all setup for subsequent weeks as well. The reply/RT/ and quote system was a little clunky, but the overall setup functioned well for what I needed.

It was great to be able to communicate with OTs all around the world on the topic. Lots of great ideas flying around, it was an exciting OT-geek time. :) The UK group also compiles all the tweets in their blog so you can review things later too. I found the experience to be fairly easy to participate in and well worth the time for the benefit. If you're wondering why you created a twitter account in the first place and would like to really see the benefits of interactions- I would really encourage you to participate in the next #otalk or #occhat you can. If interest spikes, maybe we can do more US versions as well.

Have you participated in an OT twitter chat? What topic would entice you to give it a try?

Photo Phriday: The OT Look

A recent magazine cover reminded me of these photos, which I don't think I've posted yet. I like the professional photos that I got done, but it is a credit to the photographer that I got so many usable shots of me looking like a normal human. 80% of the time that I am working with kids, my face is not perfectly posed, it's just perfectly odd. But it's ok, because this is what I think a real OT looks like.

choo choo face

helicopter face

sound effects make the day fun! I've always believed that my willingness to make a complete fool out of myself was very appealing to patients of all ages. What are your silly strategies for success?

What a feeling...

It's been a long time since I've felt THIS good about a mid-week day off. (I hope I won't regret days like this if I go from underemployed to actually unemployed. ugh... think happy thoughts...) But anyway, let's just talk about the now. The mid-week day off is sometimes better than the weekend, because it's just me, doing what I want without anyone else's expectations or plans.

I have been feeling really burned out lately. Feeling extra fatigued for awhile, starting to have trouble sleeping for the first time in a long time, and just generally feeling behind in a lot of life areas. We took in a 2-week boarder, which was a little more work than I expected and less evening down time. I knew I'd be covering the hospital solo earlier this week, but wasn't booked for prn or EI appointments Thursday or Friday, and just decided to leave it that way.

I don't know if a before and after picture could do it justice, but I wish you could take a before and after shot of my emotional state. Yesterday, I felt like a jelly brain, and today, after sleeping in, massive amounts of dishes and laundry and picking up I just feel very at peace. Anyone who knows me personally probably just fainted at that sentence. It's not that I relish in doing chores (quite the opposite!) and I've long held in doubt info about how people need crystal clean workspaces to get things done. But getting the upper hand on this little, tangible, visible part of my life has made things feel that much more secure.

so life is (at least temporarily) pretty good.

Running documents to make a job search easier

I'm still in the midst of job searching and uncertainty. Though I am trying to maintain myself in a cool, calm, collected manner, I have still noted several times that there are things I wish I would have written down to make further job searching easier. ( I have previously covered some general job searching tips for OT students that you may also find useful) Read on for tips that can save you a few headaches.

-Running Documents
There are several documents that you should always have an ongoing copy of (no, not a record of your 5K speeds). I keep my items like this on Google Drive because it is accessible from any computer or my phone, but other cloud storage may work better for you.

Obviously you should have a working resume at all times. If you're really on top of things, you could have a running CV with details of each major project you are part of listed. (I have never needed to provide a CV for a job thus far, but some fellowship-type opportunities request them)

Though it shouldn't take up room on your resume, you should keep a list of your employers' addresses and phone numbers because this is often called for on job applications.

In a similar vein, you'll want to have a running document with contact information for your references. Include phone, email, and mailing address because everyone wants something different.

In OT world, background checks are frequently required, which means you should also keep a record of your own address for the past 7 years or so. (If you hate that idea and want to stay off the grid, keeping your fingerprints to yourself- you're in the wrong field.)

For a serious job search, I keep a list of viable job opportunities. I list out whether there is an active opening, what steps I have taken, and who my contact is at the company. This lets me have 1 place to see where my prospects are, which places are calling me back, and when I last heard from them. If plan A doesn't work out, it's easy to see what other lines are still in the water.

I haven't done this, because I have proven to have widely varied and changing plans, but it might be a good idea to have a working long term plan. In this could be personal goals for how you want to develop as a clinician. Writing these goals down is the first step to making them a reality, and being familiar with your own goals is important in an interview.

Unfortunately, having these documents won't completely streamline your job application process. There have been numerous times when I just want to hand people a few of these papers (or already have) but still have to fill out some repetitive application by hand because every applicant has to fill out the standard form. It's a pet peeve of mine, but not likely to go away anytime soon, so be aware of it.

Good luck to all those searching for jobs! Please feel free to share your helpful hints in the comments below!

Getting Started in Early Intervention: Assessment

I have recently been able to get started an early intervention system, providing OT to families in their homes and communities. It definitely required a lot of paperwork to get started, but there was also a need for mental preparation and acquiring tools. Though my school system job involved using IFSPs, I was providing services in a preschool and had (ample!) materials provided. Here are some resources that I used in preparing to perform OT assessments and treatment in an early intervention setting.

I reviewed a number of assessments when I was trying to decide what to buy. Some were seriously outdated or limited the areas assessed. I wasn't able to consider others because they were made to be a true team assessment, which is true of the TBPA. While I can't speak to the practicality of using the assessment as a team arena approach, I do want to discuss the intervention book. So often, the intervention books that come with assessments are rather worthless. This is a book that I want to add into my own collection. The intervention book has many strategies to increase skills in all domains and adaptations for performance factor limitations. I think it would be helpful to anyone in early intervention because it gives you information from a multidisciplinary point of view, so it had info that I had not previously been exposed to.

After looking at multiple assessments (which had to be on an approved list), I decided to purchase the ELAP. The fact that I needed to be able to assess all domains of development, not just motor or adaptive, was a heavy factor in this decision. Also, I needed to keep costs low and the manuals and scoresheets for the test were very reasonably priced and the kit can be assembled in a non standard manner. This is a criterion referenced test which allows you to figure out an approximate age. I have friends who use the EIDP, which is even lower in cost, but I was a little worried that I wouldn't see enough during the test to get a good assessment. I also decided later to purchase an infant-toddler sensory profile (the SPM-P is not approved in my state, so it is the only sensory measure).

This picture shows some of the materials I was able to get for my testing kit. Many of the items came from yard sales or discount stores. I have always loved the pipsqueaks markers, so they were a must-have item for me. I liked the tactile puzzles we had at school so I felt fortunate to find one for sale. I found a surprising number of high quality wooden beads and blocks for cheap, which I was super happy about. The orb over on the right has spinning lights and I got it for a quarter... it is going to be a favorite toy. I need more things that make noise for kiddos with visual impairments, but the squeaky toy I got (in the pet section) is super responsive and loud, so it will do for now. Not pictured, but worth a mention is the formboard puzzle I got from Manzanita Kids on etsy. They were very responsive to my custom order, made it with high contrast materials as requested, and it is a very high quality piece.


Other Resources:
What to Expect from an EI eval- from the dual perspective of therapist and parent

Abby's blog has been featuring parent interviews which includes tips they'd like therapists to know

OT Web Gems- RSS edition

Here are some items that I had recently starred on my google reader feed and am now finally getting around to sharing. I think that on the sidebar, where I have OT & related blogs listed, you should be able to see my starred items. Here's some of the best things recently!

Jamie Oliver tells David Beckham et al to be responsible for their advertising. I could write a lot on this, and might sometime in the future. Oliver basically called out athletes who were schilling for fast food, soda, and junk food companies as contributing to childhood obesity. Whether they like it or not, athletes in the public sphere are role models, and if they are endorsing poor food choices, this could have an effect on the kids. On the other hand, I understand where an Olympic athlete who doesn't get a lot of publicity or sponsorship opportunities might feel compelled to take whatever monies that are available to them.

Linda brought up the issue that internet and computer use are now BADL. Without computer access, people may be unable to pay their bills or even access government forms. Are we accurately assessing and treating deficits in this skill?

Special-ism had an article on helping kids with Asperger's develop more flexible planning strategies. I thought this was a very practical way to approach the social skills issue of rigid thinking and planning.

The PT think tank discussed how learning and knowing has changed in the digital age. There are definitely benefits in the shift from memorization and having more access to information, but we have to make sure that our analysis and synthesis of information is not lost. Ultimately, you will never be able to discuss the full implications of a research article in 140 characters, so you still have to be willing to do some legwork for EBP.

Mothers in Medicine discussed sharing medical advice via social media, and where a physician's responsibility ends. This is a great topic I would love to see explored further. We all see people displaying questionable medical choices on Facebook or IRL, and at what point do you have to step in? How does your interference fit with ethical and legal principles? A great point of debate for those interested in medical professions and social media.

Color-coded interaction badges from a conference were discussed in the Thinking Person's Guide to Autism. I thought this was a good idea for a conference to let people know how to approach you, and a cute take to think about how that would work in normal everyday situations.

Autism Daddy (clearly a member of the sandwich generation) discussed the agony of dealing with his father's worsening Parkinson's disease. Sadly, his father has passed recently, but this look back at a family perspective of diagnosis with a degenerative condition and navigating the health and nursing care system is worth a read.

Lastly, Abby posted a TED talk on early detection of autism. I wish that I watched more TED talks, they seem to be a great thing, but between my terrible video card on the tiny lappy and my TV habit, I have a hard time getting around to it. I will get around to watching this one for sure.

Please feel free to share your thoughts on any of these 8 stories!

Photo Phriday- phinally uploaded style

Off topic: It is a little-kept secret that I use a lot of google products. Clearly I'm on blogger, I also have an android phone, and I use chrome as my browser. I do this since these products usually work very well. While I don't use google+ as a social networking option often, I've said before that our presentation team had great results with the video chatting and I also rely on the instant upload feature for these posts and for my own personal use. However, it has been very glitchy on my phone lately and only works when I actively force it to synchronize. Hopefully, they're fixing this to be a bit more "instant" as advertised, since that is the whole point. /end rant

On to the photos!

This is an old worksheet from when I was still in the schools. I thought it was a particularly unique and interesting perceptual take that this little guy started to copy the design correctly, just inverted.

Saw this cute little thermometer sign when I was back in my old hometown for high school reunion. The Junior League is apparently raising money for a universally accessible playground for the city park. I love seeing efforts to increase accessibility and really hope that accessible playgrounds start to take off in more places. There are often grants available for this kind of project, so get inspired and get one for your community!

This is a photo of my grocery list before my triathlon (which explains things like the protein drinks). I include this as another kind of hopeful note for people. 10 years ago, I would eat only 22% of these foods, and most of them would not have been things I would have willingly bought to eat (i.e. I would nibble at salad at the Olive Garden, but I never would have chosen to eat that as my daily lunch).

Had to get my scrubs out of storage when I started doing prn for my old hospital. I'm glad I didn't give them all away...

How can you tell an OT car? Mine has a sticker from OT school, one from AOTA, and this little MacGuyver'ed contraption to help me remember what I need to do everyday. It's become even more important now that I have a longer commute- just more time to forget about what I was supposed to do. But 2 papers and one of those little gold clips that lets papers rotate (what is that called?!) allowed me to make a simple reminder tool for the places I need to go most. It's a little big for the car, but it's worked out well.


I've been going to a lot of baby showers lately, it's just that time of my life. I do go off-registry for some super cool items. I have loved the Tommy Tippee crumb catch/roll up bibs and when I saw these bowls I could tell I would love them too. These bowls have corners and an inner lip to make it easier for toddlers to feed themselves.

Olympics and more!

Please be aware that I have been having html glitches with the cutting post feature, so if you start reading an entry and it doesn't fully make sense or looks too short, you may want to click through to make sure you get all the awesomeness (or subscribe with google reader and never miss an update). anyway, time to click through

One of the things about having an OT blog is that I do try to keep it OT-focused, but while there is a whole lot of OT in my life, there's a lot of other things too. So sometimes, that needs to leach in.

I made it through my (sprint distance) triathlon! I achieved my goals: no injury, no crying, and beat my anticipated time by 10 minutes. I'm really happy to be able to finish and feel well throughout the whole event. My running skills are basically nil at this point though, and I am starting the couch to 5K program over again and seeking out some professional PT help to fix my knee. I don't know that I'll be able to do another event this year, but I hope to work up to an Olympic distance triathlon and running a half marathon... maybe by next year.

Speaking of Olympics... I am a huge fan and am currently watching as many events as possible. I thought it was cool to see more representation of persons with disabilities in the opening ceremony. The children's choir featured Signing of "God Save the Queen" which was wonderful... signing can bring so much to more to songs, I love when an interpreter is included in a band or choir. The featured percussionist was also Deaf. There were a contingent of wheelchair dancers in the crazy multi-decade dance number and several individuals with physical disabilities in the cast and with the parade of nations. The best part was that this was a mostly seamless inclusion, not identified as anything out of the ordinary, just a normal thing.

The opening ceremony also featured the British National Health System and the children's hospital. This was interesting for me since in the U.S. we have been fighting over healthcare in a very extreme fashion, including people fighting for the right to not have insurance. Additionally, some of the twitter folks that I follow are service users for the NHS and it seems like while it may not be as heated as our current debate, I didn't expect it to be such a source of pride to be included in the ceremony. UK readers, feel free to let me know how you felt about that.

So that should give you an idea of how my free time will be spent in the coming weeks... Also we've had out of town visits for old friends and my brother is getting married, so I will be pretty busy. Will probably have to avoid twitter to a degree so that I avoid spoilers to the events (my husband already revealed some swimming results too early). Hope you all have a lovely day and that the feats of strength inspire many people to physical activity!

Life moves pretty fast sometimes...

So as I was driving back from a job today and struck by an interesting reflection, that in an introspective way snowballed into a larger reflection.

Way back in early 2007 as part of my management class, we had to do a project where we outlined how to start a clinic or business. Any field of OT, any location, but needed to be very thorough. I tried to make mine as realistic as was feasible. I chose to focus on the area where I would be living after graduation, chose to have an outpatient clinic specializing in spinal cord injury and back injury (because there was no specialty clinic anywhere near the location and it was a personal interest), and picked out the office building to rent. It was an interesting project (as interesting as anything in your final semester can be), got a B, no biggie. Though I thought it was a great idea, I didn't seriously entertain that I would ever attempt to start my own business.

I am a person who feels compelled to immediately repay $1 borrowed from a friend, so the idea of applying for a hundreds of thousands of dollars loan (or more) is absolutely terrifying. I don't know that I could have the guts to "go for it" in the way needed to have a real business start up.

I think it was a couple of years ago that I was at an NBCOT volunteer meeting, chatting with some of the most awesome OT people in the country, that I was griping about my situation in the hospital. There was a lot to be frustrated about, who can really remember what specific complaint it would have been, but I think it must have been about reaching the pediatric population effectively. The response I got was "start your own business" and you probably could have knocked me over with a finger. How could I do that? I don't have enough experience or funds or or or or... I didn't see that as a feasible possibility.

So I drove by the office building that I had picked out over 5 years ago as my SCI clinic (Spine Care Institute: Back to Life TM) and noticed that it is now a cafe. Will that business succeed? What were their thoughts and fears when they started? I know not. However, in those same 5 years, I have sort of become a small business owner by becoming an independent EI practitioner. Got my own little cutesy business cards, a business address (itty bitty PO box), fill out my own bills, that kind of thing. It doesn't quite feel _real_ yet, but it is essentially true. I didn't really imagine that I would be _here_ maybe ever, an certainly not now. But that's how these things happen, I suppose.

I'm still waiting to find out what is possible in the coming year. For awhile, we thought we might be abroad for 2 months (?!!!) which would have been both crazy and cool, but it looks like that has fallen through. Being unsettled in this area is frustrating. I know that I'm in a holding pattern, and it was making me very stressed and worrisome. It's been getting better, and in a current study an applicable word came up. "Hupomone" means patience in situations, and get translated as perseverance and endurance. The root word is that for "hope." So I continue to hope and for now, that's working.