Entrepreneur Series: Sue Ludwig and NANT

This installment in the OT Entrepreneur Series is Sue Ludwig, president and founder of the National Association of Neonatal Therapists (NANT). This is a professional organization designed to support, network, and educate the OTs, PTs, and SLPs in the NICU.

  What was your background before starting your business? 
 I’ve been an occupational therapist for over 20 years. At least 17 of those years have been spent in the neonatal intensive care unit (NICU). For the past decade, I’ve also been a national speaker as well as a consultant to NICUs in the US in the areas of neonatal feeding, developmental care and leadership. 

 Why did you decide to start your OT business? 
 I started the National Association of Neonatal Therapists (NANT) for several reasons, including: 
 1) as I consulted around the US, I realized that therapists who worked in the NICU had no way to connect with each other. Often we didn’t even know of another therapist who did what we did! We were isolated and didn’t know where to go for specialized education, mentoring or validation. That also meant we recreated the wheel for every project, goal, and directive. 
 2) Every neonatal therapist I met was passionately invested in their practice. They LOVED working in the NICU. And they were self-motivated which is something I admire in anyone.
 3) The babies in the NICU deserved knowledgeable, highly specialized therapists. You can do harm in the NICU if not properly trained. This gnawed at me.
 4) I had more to give. I had a vision. It just took me a long time to believe that I could be the leader of this grand endeavor. 

 What was your tipping point to get started? 
 I had previously worried about if I would have the approval of my peers when starting and leading this organization. I wasn’t sure if I fit my own definition of a powerful leader. My mentor kept telling me, “No one is going to anoint you worthy. Only you.” (This statement stops one in her tracks.) I remember lying in bed one night wondering how I’d feel if someone else decided to start this organization. I was afraid they wouldn’t have the same perspective or that they’d limit it to one discipline. It was then that I realized that I did, in fact, have a very specific vision and I wanted to see it come to life. 

How did you take your first steps to starting a business? 
 My first step was to hire a business mentor. I still have the same mentor 5 years later. This was a critical and invaluable step. We need to learn from those who are several steps ahead of us. High level mentoring saves time, mistakes, and money while adding depth, strategy, and forethought to business. I’m thrilled that this is the route I took. 

Have you found a benefit from social media marketing (twitter, facebook, blogging)? What are some of the strategies that you have used to maximize your success in this field? 
 Yes I have found huge benefits from using social media. I’m not sure many businesses can afford NOT to have a social media presence. I have a very personal approach to all of my communication, whether it’s social media or our weekly newsletter. I did not want NANT to be just a ‘big organization’ that didn’t relate to its members. I AM them. I want them to know I have their backs. Everything I do is to support them professionally and personally and in turn, support babies and families.


What were some lessons that you learned in the initial stages of your business? Were there challenges that were difficult to answer during this time? 
I learned thousands of lessons. I learned that I actually really love business (who’d have thought?!). Being an entrepreneur is stressful and highly rewarding. I learned that my colleagues around the world are doing amazing work that often goes (or went) unnoticed. I learned that every NICU in the world needs therapists who see infants through our unique lens. I learned that there are many opportunities out there, but to let my true vision guide the choices I make. If the opportunity isn’t in alignment with that vision, I let it go. The challenges were similar to those any new business faces: learning how to hire the right people, how to make the business more scalable, how to avoid being the bottleneck for decisions and creative content. Each challenge helps me grow and learn. It’s not for the faint of heart. 

How long did it take for you to hire additional help? 
 I hired help before NANT even went ‘live’ in the world. My mentor was very clear in teaching me that there are some things I just never need to do. That I could start small (hiring-wise) but needed to learn to delegate immediately to people who were fantastic at executing work that I should never do. That way I could focus on what only I can do. This was sage advice. 

 What was your original goal, the hope you have for the business? 
 My vision was for NANT to become a sustainable business so that we could keep serving our members. But my goals are more long-term. I’ll consider it successful if I leave a legacy…if NANT outlives me and continues to thrive beyond my wildest imagination…if neonatal therapists fully understand the value they bring to the NICU team and stand in that value – humbly, decidedly, intentionally.  

What is the best thing about owning your own business? The worst? What surprised you most? 
-The best thing: Freedom. Being able to bring my kids to school or be there for sporting events and other important moments. Even if it means working extra hours on other days, the freedom to be present for my husband and kids is priceless. I’m also so grateful to work every day toward a vision that inspires me, grounds me and pushes me. Not everyone loves their work. I am fortunate that I do. 

-The worst: The stress of responsibility. I want to make sure I’m moving this field in the right direction. Luckily I’m surrounded my amazing colleagues who contribute to this journey. 

-What surprised me the most: Selling out our first national conference in 2011! And the nearly instant acceptance of NANT by other neonatal associations and professionals as well as AOTA. The neonatal community is small (no pun intended) and I’ve found it to be supportive beyond measure. 

 What are some tips that you could give to OT practitioners considering starting a business? 
-Be prepared to live outside your comfort zone- personally, professionally and perhaps financially at first. This isn’t a bad thing. You’ll emerge stronger. 
-Get a mentor. You might have your MBA already and that’s great. It’s just not the same thing as knowing the steps to take when you begin on Monday morning or how to implement all you know. 
-Consider your true motivation for starting the business. All the money in the world won’t make you want to get out of bed and work at a job you hate. Look for the deeper meaning and stay true to that vision. 
-Have fun with it! Surround yourself with people who buoy you and are not prone to drama. Support them in the same way. 
-Be kind to yourself. Schedule self-maintenance. Sleep. 
-Understand that you have a unique contribution to make to the world. Express that through your business to serve others.

Many thanks to Sue for sharing her perspective on business ownership! If you're thinking of practicing in the NICU, NANT is a great resource to make that a reality. Check out their annual conference and website!


Entrepreneur Series: Tonya Cooley of Therapy Fun Zone

This special Thursday-edition of the OT Entrepreneur Series features Tonya Cooley, author/owner of the Therapy Fun Zone blog and online therapy store. Tonya is a prolific OT blogger and has some great tips on starting down that path for others.

Can you tell me a little about your business?

When asked questions about my business, it is a little difficult to answer because it is not straight forward, and it is very atypical. Therefore, I will first explain what my business is. I currently work contract for a school district as an OTR, and in my off time, I run a therapy blog called Therapy Fun Zone. I post about fun and different therapy activities to help inspire creativity. I also create therapy games and share some for free, and some are available to purchase. It is the blog aspect of my business that I will focus on since it is interesting and unique.

Why did you decide to start your business? I initially started Therapy Fun Zone near the end of my first year as a school therapist. I was a very experienced therapist, and had been treating kids for 20 plus years, but most of my experience was in a well-established setting with plenty of home program and activity resources, so I never lacked for activities and inspiration. When I started in a small school district, they had never had their own OT before, so they had no eval template, no worksheets, activities, or toys, and no home program resources. I was also not used to working with kids that were so high functioning, and needed to come up with some activities that would really challenge them. I scoured the web to find ideas and had to make some stuff of my own. Then I had a parent tell me that their last therapist only worked on practicing the same thing over and over, and she loved how I made the activities fun. That really hit a nerve, and I don't think children will fully participate in therapy if it isn't fun.

It was right after that exchange that I decided to make my own website for fun therapy activities in order to make it easy for people to find them.

Can you share a bit about the financial side of your business?

When I started Therapy Fun Zone, I had no expectation of making money. I just wanted to share ideas and connect with other therapists. I was already set up as a business though because I had invented a baby product a few years earlier, and already had a business license, business bank account, business name (TMC Adaptations), accounting software, and a tax id number. I made a lot of mistakes with my baby product (Hug n Hold) financially, and so I tried not to make those with Therapy Fun Zone. I planned to just spend my time on it, and not spend money on it.

Have you found a benefit from social media marketing? What are some of the strategies that you have used to maximize your success in this field?

Therapy Fun Zone is essentially dependent on social media as it is a blog, and I get a lot of traffic through the blog from facebook and pinterest. I would say that some of the keys to success with blogging and social media is to get on a schedule. I have been blogging on and off on other sites since 2005, and none have been successful until Therapy Fun Zone. From the beginning I had to treat it like a business even though it wasn't making any money because I wanted it to be successful even if it wasn't in a monetary way. I post at least once a week, and people can count on that. Sometimes I schedule my posts way in advance, but make sure they are spread out to once a week. I have seen some therapy blogs that post a bunch of articles all at the same time once a month. That does not work in your favor. If you have a bunch of articles, don't post them all at the same time. Spread them out and keep people coming back at a steady pace. I have also found that I can't keep up with more than once a week and get completely burned out. I also then post my blog posts to facebook, pin on pinterest, and then share other people's interesting things on facebook and pinterest.

What were some lessons that you learned in the initial stages of your business?

I would still consider my business to be in the baby stage. I am still learning a lot, am getting better and more efficient, and am learning the extra computer design stuff. Maybe in my next life I will be a computer programmer. Financially I think that I currently break even, or make a couple hundred dollars a month. It is not yet an option for me to quit my job, and if I did, where would I get the ideas for new therapy activities. I think that the website may finally now pay for the web hosting. Maybe someday it will pay for more. The moral is, if you think you can make a bunch of money by blogging, don’t kid yourself. It is a lot of time expense with no financial reward, but it has other rewards. I consider it a success because it is currently one of the largest therapy blogs out there, and gets over 100,000 page views a month. In big business blogger terms, that isn’t a lot (they get 1,000,000 hits a month), but in small OT blogger terms, it is darn good.

Button Pizza... yummy ADL
What was your original goal, the point that you aspired to reach and consider that you had "made it" as an entrepreneur?

My original goal was to share therapy ideas, and I think that I have definitely accomplished that. In the beginning, I wanted Therapy Fun Zone to not suck as a blog/website. I now think that it is pretty awesome, and I am quite proud of myself and my website design skills. I am currently working on taking it to the next level, and making it more of a joint effort. I recently added a new shopping cart that makes it so that other therapists can sell their products on my site too. I think that it could be really useful to have all of the resources that therapists make out there and available to other therapists. We will see where it will go.

What is the best thing about owning your own business? The worst? What surprised you most?

The best thing about having started Therapy Fun Zone is that it really stimulates my brain, and it keeps me inspired. The worst part is keeping track of the finances (not my thing). Most surprising is how much I love making therapy games, and that I enjoy website design. I am also surprised to find that I don’t like writing. My joy comes from creating, but then I have to write about it or no one else can benefit from what I have created.

What are some tips that you could give to OT practitioners considering starting a business?

As far as advice about starting your own therapy blog, I say just do it. Either you love it or you don't, and you never know where it might take you. Specific blogging advice would take many many posts, so I will try to work on those over at Therapy Fun Zone. If you want to try your hand at creating products, come join me and open up your own shop at Therapy Fun Zone. You could try your hand at blogging by being a guest blogger too.

Either way, you must have fun.

Thank you Tonya for your insights! Very helpful information for our next era of OT bloggers and innovators! Be sure to check out all of Tonya's fun activities on her blog, facebook, or pinterest sites. And come back next week for our last interview of 2013!


Entrepreneur Series: Paul Fontana, Center for Work Rehabilitation

I am very pleased to present the next interview in the OT Entrepreneur Month Series- Paul Fontana. This is an exciting moment for me since Paul is the first "OT celebrity" that I ever met, so it's great to be able to share this story. Paul is the owner of both the Fontana Center, a fitness center that offers OT and massage therapy; and the Center for Work Rehabilitation, a multi-functional industrial rehabilitation and consultation business. Read on for some great insights on starting a very unique business.

What was your background before starting your business? How did you take your first steps to starting a business? Did you have a mentor?

I was very fortunate to have worked for a private practice contract company in northern Indiana. The company would contract to provide OT / PT services to hospitals, schools, outpatient clinics, home health agencies, etc. Our owner, Mr Jack Gamet, RPT understood that the OTs and PTs that he hired did not go into therapy to run a business. So if he did not train his key people on basic business principles then he knew that his business and how to manage both people and the business that we would soon become unmanageable. So Jack purposefully decided not to accept one new contract for a year while he hired expert in the field of management to teach his select group of therapists how to become managers - they taught us strategic planning, goal setting, budgeting and financial planning, supervision and leadership skills training, program development and marketing / selling technique training, etc. I was fortunate enough to be one of the therapists selected to participate in this training.

As I developed the programs at 2 sister hospitals that I was the chief OT for, my immediate supervisor, Mr Thomas Cole, OTR brought me up into an area supervisory position where I was then charged with assisting other facilities with program development and growth. Under Tom’s leadership and growth I learned how to analyze a business potential objectively looking at my strengths and weaknesses from a critical standpoint, develop a business plan then analyze that plan critically to see if it would be worthwhile. This process of leadership development was quite successful as we eventually grew to have facilities in 9 different states.

As I progressed in the company I eventually became Director of Operations for the OT / ST divisions. As such part of my job was to look to the future and develop strategic plans to ensure the growth of the OT and ST programs offered by the company. In the early 1980’s managed care was just beginning to appear on the horizon and from where I was it appeared the goal of managed care had little to do with quality improvement and all to do with cost containment. And this centered around reducing the payment to the providers. At the same time Medicare underwent some significant changes that had the potential to adversely impact our business. As part of my job of looking to the future and trying to ensure that our company was strategically aligned to meet the changes on the horizon, I heard about this "new" concept in care that was being performed out in California – work hardening and functional capacity evaluations.

I traveled out to California and spent a significant amount of time visiting Dr Leonard Matheson (clinical psychologist) and Linda Ogden, OTR who were running the program. I became convinced that this was the future for OT for our company. This was an area of practice that centered around occupation and in my opinion was a perfect fit for OT. And no one was doing it in the 9 states that we had facilities. I brought this concept back to my owners (jack had sold out and there were now 4 owners) but they said that the company was in the medical business and they were not interested in expanding out into this area of practice. I decided that this was an area that I was interested in so I gave the company a 1 year’s notice and made plans to open my own clinic in this area of practice.

My time with Restorative Services and through the mentoring of Mr Jack Gamet, RPT, Mr Tom Cole, OTR and Dr Leonard Matheson I believe that I had the skills and knowledge base to venture out on my own into this new area of practice. Using the strategic planning / program development skills that I learned I was able to do market analysis in the states that I was interested in working thereby helping me to narrow down the state that I would eventually move to. Furthermore the fiscal management and budgeting training helped me to plan for the future as well as help both myself and my wife to feel comfortable with my decision .

Prior to my moved to Louisiana in 1986, Dr Carolyn Baum was very helpful in allowing me to spend time observing in the work hardening program that she had at Washington University in St Louis. In addition to this I spent several weeks working in south Louisiana meeting with potential referral groups (physicians, rehab nurses and medical case managers, vocational counselors), insurance company personnel and claims adjuster as part of the environmental analysis to see if my idea of the industrial OT programs would a) be reimbursed, b) whether there was any competition, and c) whether or not I could get referrals.

To this day I am convinced that without the mentors that I had that I would never have been able to develop the industrial programs and sustained the business that has served the communities in south Louisiana and Houston Texas where I have clinics for the past 27 years. I did not get an MBA but feel that with the executive management training that was provided by my company and the mentoring I had from both Mr Gamet and Mr Cole that I had the necessary skills to move forward with my own practice.

Nobody likes talking about money, but how long did it take for you to turn a profit/hire additional help/be able to quit your other jobs?

When my wife and I decided to open up our own business I did not have another job, nor was she working outside the home. She felt comfortable that I had done the preliminary work and that I could make this work before I announced that I was leaving my job as Director of operations. We did the budget to see what was the absolute least amount of money we needed to bring in to keep the roof over our heads and the family fed for the first year and were confident that we had enough in savings to get us through until revenue started coming in. Also, being an Occupational Therapist where I knew that if I needed to I could always do home health in the evening and weekends if I needed some additional revenue to keep us going until the business took off was a very valuable help.

When I opened the Center for Work Rehabilitation in 1986 I was the only employee. I not only did all the marketing but evaluated the clients, typed my own reports and performed all the rehab on the clients. It did not take me long before I realized that I could not make money at this by typing my own reports. Within the first 6 months I was in the black, paying all my bills, including paying myself enough to keep the roof over our head and food on the table. By the end of the first year I hired additional professional help to allow me to get out of the clinic to meet new customers, stay in touch with current customers and perform work on site to ensure growth.

With the ups and down of the business I have had years where I made more money as an OT than I ever imagined I would and other years where I paid my OT Technicians more than I took home, just to keep the business open. At one point my wife and I had to liquidate all the kids’ college fund monies we had set aside just to keep the doors open until the industry turned around, which thankfully it did.

What were some lessons that you learned in the initial stages of your business (first year, first five years)? Were there challenges that were difficult to answer during this time?

Having worked in a private practice environment before opening my own business I already was used to working long hours and even 7 days a week if need be. Therefore this was not something that I had to get used to. Luckily the business growth was close to what I predicted and my wife was able to stay home with our growing family. This was an important aspect of the growth and financial wellbeing of the company because as I was making inroads with industrial customers I would be called to travel to job sites, including to offshore drilling rigs, salt mines, and manufacturing facilities out of state where I would be working for multiple weeks at a time. Some of these requests were spur of the moment where I did not have time to preplan but rather had to be at a heliport in 4 hours. Had I not had the advantage of a supportive family this would have been extremely difficult.

The business model that I was developing was something the insurance industry as well as the physicians were not exposed to so I was starting from scratch to get folks to understand what I was doing and why. At times this was difficult.

Having grown up with ethical training (where my word and a hand shake was sufficient for work) had some drawback as associates I worked with took my idea and opened their own programs to compete against me. That was a challenge that I did not anticipate having. I was also surprised to have physicians directly and indirectly seek compensation for referrals – “what’s in it for me” was asked of me by several important referral sources. Another important referrer wanted me to train LPN’s how to do therapy then give him space in my clinic where he would send all his clients and my professional staff would provide the supervision. When I told him that I would not do this as I felt it was both unethical and illegal his response was, "I have 300 – 400 clients that I can send you".

Developing "partnership" with my industrial customers was a huge asset to my business. By becoming a critical part of their "fit for duty" program I had customers provide me with equipment needed for simulations, access to their training to improve my knowledge of their business, etc. At one point when I was unable to access my equipment nor facilities until the courts intervened, the Vice President of Human Resources for a major drilling company told me “I cannot run my business if you are not in business.” In 2 days I had use of an 8,000 square foot warehouse to use as my clinic. During another time when the price of oil dropped to such a low that made drilling in the Gulf of Mexico too expensive that companies stopped all hiring, one of the claims manager for a major drilling company asked me how this was affecting my business. I told him that business was so slow that I may not be able to stay in business. A week later I had a contract to travel offshore and develop 31 physical job descriptions for this company. The claims manager told his boss that they needed to make sure that I stayed in business because when they needed me to rehab their employees, I needed to be there.

What is the best thing about owning your own business? The worst? What surprised you most?

It allows me to set my agenda professionally, to devote time and energy on giving back to the profession. I did not have to get approval from anyone to spend the time / energy to become actively involved with the Louisiana OT Association (President for 4 years), AOTA (Region III PAC Chair then AOTPAC Chair followed by a term as a Director on the Board then Secretary to the Board of Directors). I enjoy the opportunity to work with business and industrial customers who are generally only interested in results. Being able to go on site, help them with problem resolution and implementation is what I like best. That and this work allows me to do a fair amount of teaching which I really enjoy.

Worst can be the lost family time. Working with industrial customers as a private individual you have to be there when they call or they may go elsewhere. There were vacations that I missed because of a job request or because a therapist I had working for me quit so I now had to miss the vacation to cover in the clinic.

Also, having continual staff turnover. Many of the OTs that work with me stay 1 ½ - 2 years then leave to work in the hospital, out patient clinics or nursing home for fear that they are losing their “treatment” skills. That certainly is true. Having worked in this industry for 27 years I cannot imagine how to treat a stroke patient or a pediatric client. However I have skills that others do not have. But trying to find clinicians to work in a non-climate controlled environment doing industrial fit for duty programs and not having to retrain every 2 years has been tough.

What are some tips that you could give to OT practitioners considering starting a business?

- First and foremost have a mentor. Not only regarding business management but therapy skills management

- Be ready to devote the time and energy it takes to make it work

- Be sure to do a good objective market analysis and self analysis of your skills and abilities before hand

- When planning financial areas, although you need to be realistic, be extremely conservative regarding revenue generation and high on cost expectations. If you can make it during the worst case predictions you will be ok. If not, you may need to re-evaluate. Things beyond your reach of influence will occur.

Thank you so much Paul for your detailed responses! Great wisdom regarding mentorship, needs assessment, and preparedness. You can learn more about the business at the Fontana Center Website - http://www.fontanacenter.com/


Entrepreneur Series: Christel Seeberger of tOTal Ability

Today's entry in our ongoing series reflecting OT Entrepreneurs is Christel Seeberger of tOTal Ability, a private practice in Canada with a secondary online resource store.

Why did you decide to start your OT business?
I was an occupational therapist with almost a decade of experience in different countries (Canada and the USA) and a variety of settings with a clientele across the lifespan before starting my private practice in 2002.  I decided to start my private practice while training to run a marathon.  I run very slowly, so I had a lot of time to think!  I thought a lot about occupational therapy and gaps that I saw in the public system.  I was motivated to fill the gaps.

How did you take your first steps to starting a business?
I started small and really built the practice client by client. I sought out both formal and informal mentoring opportunities, many from women in business style entrepreneurial groups.

Have you found a benefit from social media marketing (twitter, facebook, blogging)? 
Using social media is like learning a new language!  What I appreciate the most about using social media is being connected with such a huge community of knowledge and leadership.


What were some lessons that you learned in the initial stages of your business?
A lesson that I am still practicing every single day is to say, “no”.  It enables me to say, “yes” to something better in the future.

How long did it take for you to turn a profit?
One of my oft quoted personal and business mantras is, “only spend money you have, on things you really need”.   So, I have always made a profit from day one, never spending more than I earn to grow the business

What was your original goal, the point that you aspired to reach and consider that you had “made it” as an entrepreneur? 
Like many entrepreneurs, I started out creating a job for myself.  My private occupational therapy practice ( www.totalability.ca ) has grown, now with 8 contract OTs on the team, and we provide mobile occupational therapy in three cities in our province.  It was only when I started my second business, www.totalabilitysolutions.com which has downloadable eBooks with occupational therapy resources, activities and advice for parents, teachers, caregivers and professionals that I realized, I truly was an entrepreneur.

What is the best thing about owning your own business?
My worst day running my own business in private practice is still better than my best day in public practice working for someone else!

What are some tips that you could give to OT practitioners considering starting a business? 
Do your research first!  Not every idea you have is a good one.  Be business smart.  As occupational therapists, I think we always want to help.  But when you make smart business decisions you get to help more people at the end of the day.

Thanks to Christel for participating in the series! Definitely some great advice on being business savvy and improving the OT world. Be sure to check out tOTal Ability around the internet to see great OT content!


Entrepreneur Series: Chris Alterio and ABC Therapeutics

This entry in the OT Entrepreneur Interview Series is Chris Alterio of ABC Therapeutics, a pediatric private practice in New York state.

What was your tipping point to go into private practice?

I was a part time private practitioner since my entry into the profession. At first I did contracting and home health care in addition to my primary employment. I think that this is a very common entry point to private practice for many therapists.

Over time I learned that I enjoyed my consulting and contract work much more than work within institutions. Most of that likely has to do with my own sense of intrinsic control that I prefer to have over my work, and sometimes working within institutions felt somewhat stifling.

A tipping point for me came after a period of employment where I was very disenchanted with the power structure at my job. I was working in a hospital that was going through a merger and it was stressful in many ways. I disagreed with the strategic direction of the institution and of my supervisors and it was no longer a healthy 'match' for me. At that time I 'liberated' myself and began my private practice, which initially involved private pediatric home care. That is how ABC Therapeutics was started - 14 years ago!

I hired my first employee sometime in 2003. At one time I had nearly 25 employees, but I did not like the 'feel' of that as it seemed I was spending all my time with personnel management and contracts. I prefer the intimacy of the private clinic and home care - so now we do very little contracting and I have decreased my staff rather significantly. When I had a larger staff I felt like I was turning into a contract agency and that is not what drew me into private practice, so we refocused our efforts on outpatient clinic and home based care.

What was your original goal, the point that you aspired to reach and consider that you had "made it" as an entrepreneur?

My 'original goal' was to help families interact with their school systems and learn how to navigate their systems and advocate appropriately so their children could receive the most appropriate services. Families were seeking out private in-home care with me because they were dissatisfied with their school-based services. In the beginning I believed that I would spend 2-3 years educating families and helping school districts to appreciate what these families wanted - and then things would just be 'better' and there would no longer be a need for my services. That was incorrect thinking.

What I learned over time is that although the people working within these systems are generally kind and they generally have the best interests of the children in their hearts, the systems themselves are unwieldy and overly bureaucratic and in fact they are not always designed to be user friendly for parents. I am not sure why it didn't occur to me, but this was precisely why I wanted to leave institutional employment! So, it was a rather naive thought that I would 'fix' these systems from an external perspective when I couldn't even fix them from an internal perspective!

So after a while I came around to a new way of thinking, and that was that there were a lot of needs in the world and that it was my goal to help parents meet those needs no matter what the systems in place were. Sometimes that means working within those systems. Sometimes it means helping families doing things on their own. Each day that goes by is a reminder that the work will probably never be done, because each day the phone rings and it is new people calling.

With regard to measuring if I 'made it' as an entrepreneur, I never really consider it all too much. In honesty, at the end of each very long day I walk through my building and look around at the equipment and I remember the echoes of children's voices - and I actually just give thanks and say a prayer for how blessed I am to be able to do this work every day. Those moments, at the end of each work day, kind of help me to keep things focused.

How did you take your first steps to starting a business?

I had some concerns about my ability to support my family and start what seemed to be a risky venture at the same time, so I took a position as academic fieldwork coordinator at a college and used that as a 'base' while my private practice grew. I was able to complete the fieldwork coordinator tasks on a part time basis and this gave me the flexibility to develop my business.

Early on in the process I learned a lot of information by trial and error. Over time I learned what I needed an attorney for, what I needed an accountant for, and what I needed marketing consultation for. I developed a network of other small business providers who in turn provided their expert services to me.

My early success was attributable mostly to the experiences I had previously in paid employment as a Supervisor. I already understood personnel management, and I had experience with billing systems, and I understood the care delivery systems that I was interacting with. With the help of consultants to guide and teach me about areas I did not know I was able to develop a solid base for my private practice.

After three years I was able to leave my position at the college and focus on the private practice full time. Also, at that time I returned to school for doctoral study. That experience was also instrumental in my professional development and I want to emphasize my appreciation for my doctoral program and the excellent faculty at Nova Southeastern University.

Have you found a benefit from social media marketing (twitter, facebook, blogging)?

I began blogging in 2005. In one of my first posts I wanted to express to whoever might be reading what starting a private practice was like. I was still struggling with the technology and quirky inconsistency of the format and I was unable to upload a picture that captured my feelings. This is what I wrote:
"I wanted to talk about private practice, and perhaps talk a little bit about what I went through in the last 36 hours, and perhaps talk about a broader desire to help other people get involved in private practice - but now that I can't upload my picture I am feeling a little deflated."
It was of Thelma and Louise, flying over a cliff, preferring to face death than capture. That is kind of what entering private practice is like. I am not sure how important my blog was for promoting my practice specifically. In many ways I think the blog is more widely read and considered by OT colleagues, and in fact that is mostly who my topics are intended for.

I did not start social media marketing until 2009 and by that time my private practice was fully established. Again, I do not know if social media marketing was directly responsible for reaching an audience about my practice. Rather, I believe that what happens is that if someone Googles 'ABC Therapeutics' then they see a heavy web presence. That may matter to some people - and if so - then I suppose that social media marketing is helpful in that regard. Actually, I think that more traditional print and other media has been most effective for direct marketing of my business. Social media is supportive.

What is the best thing about owning your own business? The worst? What surprised you most?

The best: The ability to serve. My 'bosses' are the families. I get to tell kids daily - "YOU are the boss of ME!"
The worst: Financial concerns, payroll, cash flow management, frighteningly high account receivables, and of course the uncertainty of health care in general these days.
Surprising: My ability to very effectively manage the worst parts of it successfully!

What are some tips that you could give to OT practitioners considering starting a business?

Every day brings new lessons. Every day is an opportunity for more learning and more growth. If I learned anything early on, it was that I need to learn lessons every day. I think that when I first started I didn't realize that.Continue your education, every day. Identify a passion, believe in it, and live it. Finally, don't be afraid of holding tightly onto the things you believe in and speeding over a cliff.

Thank you so much Chris for your story! Please be sure to check out the ABC Therapeutics online world including great blog entries from Chris.

ABC Therapeutics Website!
ABC Therapeutics Blog! 
Like ABC Therapeutics on Facebook!


Happy Entrepreneur Month!

It's been a long time since I've done an entry... definitely a lot going on it Cheryl-world. Though I haven't had a lot of time to sit and put my ideas to paper, I did take a page from my internet-pal Abby and will be running a series of interviews this month.

November is national entrepreneur month, and I want to take that time to recognize some super OTs who have braved the business world. Many people aspire to start a business or create the job that they truly want. I hope that the interviews this month will provide some inspiration to students and practitioners, and some guidance about what the "first steps" would be to get started.

Stay tuned for some terrific stories of OT success! A new entry each Tuesday of November plus extras thrown in!


Life is just... yikes.

Obviously I'm not back from my self-imposed blogging maternity leave. So where am I? read on... 

 My life is pretty much completely crazy right now. (that's the TLDR version)

People have said "having a baby changes everything," to which I reply, "true that." Personal schedule has been completely hijacked and we now semi-rigidly adhere to certain time principles- up at 6, out the door at 7, pump at 12, etc. While I couldn't "sleep while the baby sleeps" when he was young, now I follow this religiously, heading to bed myself at 830 or 9 every night. A big change for this night owl... thank you to International Delight Mocha and Cranergy for making mornings possible.

Getting up at 6 everyday because post-baby, my dream job opened up, and I started new employment for what I anticipate to be the last time for a very long time. I am now a school system therapist and enjoying the transition back to working life. 

and since a little change is no fun, I also got a new phone and will be using a new car to do my work driving. 

Stress abounds. I've had to change my MO for pretty much every aspect of my life. I'm still reclaiming some of my identity and expect that will continue for awhile. I love my blog and want it to continue, but finding the time is a challenge. So I'm reevaluating how to do business here. I may start having some more guest posts, some shorter posts, things of that nature. I probably won't be using my facebook page very often but still do a little on twitter since I can operate it on my phone. I still have tons of ideas that I want to write about, it's just about finding the time. I may see if I can use speech to text features on my devices to see if I can dictate while driving between schools (all 14 of them) or while pumping.

So please be patient with me as I adapt to my ever changing life roles. It's hard. 
I intend to post an update to the entry on using baby massage (now that I've had a real live baby to practice on) and get the giveaway out now that I figured out how to determine all the followers. 
Also, there will be a special feature in November, so stay tuned for that! 


Breastfeeding the Child with Torticollis

In honor of World Breastfeeding Week, I decided to prioritize writing this piece. Torticollis is a common issue for infants and as I found personally, it can complicate breastfeeding considerably. Despite these factors, torticollis is often unrecognized and information on how to troubleshoot breastfeeding in this circumstance is limited. So this piece has information that I have gleaned from a few sources, my own OT background, and my recent experience with my son. 


c'mon get Appy (part II: Android)

Editor's Note: As we discussed last week, I started these entries soooo long ago. Lots has changed since I started the post but since I do have an Android device I use these apps more frequently. I have included resources for more information at bottom of the page.

I have an Android phone and have used these apps at various points. When comparing Apple and Android, there are a lot more free apps on the Android store, but they don't always work across platforms. So things like the Handwriting Without Tears app don't connect to my phone, so this is definitely a limited list. These are free unless otherwise noted.

Treatment Apps

Activity Timer Trial - this is essentially like the Time Timer, where you can watch the time disappear. You can customize the color of the timer and the length of the timer. I have the trial version of this, which only goes to 10 minutes, but I never really need to measure longer than that during a treatment anyway. My gripe with this is the same as with all Time Timers, that the kids sometimes fixate on watching the time disappear instead of whatever they are supposed to be doing.

Ultrachron Lite - this is a stopwatch and timer application that works well. The free version tracks a history of 10 times if you need to time several things in a row. 

Balance Ball - This game is really hard. You try to balance the ball between two clowns who are blowing on it. I can't make it longer than 10 seconds, so it's really too much for the kids.

Beautiful Bubbles - this is very simple and good for a little diversion if needed. Bubbles float around and you pop them. The free mode just allows you to pop the bubbles as you wish, and the challenge mode gives you points for popping the bubbles quickly and accurately. 

Double Balance! - this is another game that is deceptively hard. You are balancing one ball on a platform at the same time that you have to bounce a second ball off another platform. Moving the bounce platform causes the balance platform to move too. 

My First Tangrams Lite - Such a cute little app. It uses basic shapes and you drag them into the outline to form a creation like a butterfly or flower. Obviously there are a limited number of puzzles with the free version but it operates very well.

Tangram HD - This is the app that I use when I personally want to do Tangrams. It has multiple categories of puzzles and a large number of puzzles per category. The only issue is that you have to complete one puzzle before moving onto the next. 

Labyrinth Lite - This operates just like the old wooden labyrinth games. The nice feature is that you can connect this to a computer based account and make your own mazes.

Intellectual Education - This is a game with a little Japanese penguin that lets you choose matching or memory games. It's pretty cute and appeals to the kids.

Instant Heart Rate - I use this for myself, but if I worked in home health, I could see using this more in practice so that I could monitor vital signs. The app uses the camera to measure the heart rate and has been accurate for me more than 80% of the time. It offers you the option to save heart rates and a range of normal  values.

Memory Trainer - I love this app, and use it for myself. it allows you to do memory training exercises (games) in different categories: visualization, working memory, chunking, focus, spatial memory, and fluid intelligence. You can work up levels or choose a specific game to practice on. 

Relax Me - I haven't tried this out too much but it offers guided progressive muscle relaxation.

Black and White cards for the baby - This app allows you to pick a variety of black and white visual stimulation cards and choose time intervals, music, and movement for them. Apparently after a recent update they've started pushing more advertisements, I hadn't had this problem but I don't leave internet on all the time.

Classic Simon - exactly what you think it would be. I miss Simon.

Tactical Breather - this is a great app for relaxation and a bit of biofeedback. It gives visual cues for breathing- inhale/hold/exhale/hold all for 4 seconds each. I wish that you could customize the time frame because my kids can't really hold their breath that long and another program I use wants you to do inhalation for 4 seconds and exhalation for 6 seconds. But it is a simple and effective app.

Kids Preschool Puzzle Lite - Drag the pieces into the outlined slots to create the puzzle. Simple and cute.

MyChain widget - This is based on the Jerry Seinfeld concept of creating of chain of days that you met a goal.  The widget sits on your home screen and is labeled (briefly) for your goal. When you follow through, you touch it and it turns green and adds another number for that day. You also get a positive affirmation. Miss a day and it goes red and you start again. 

Other Apps

Due Today - I love this app, it is one of the only ones I have paid for ever. It's a very customizable to-do list based on the principles in Getting Things Done. Read my full opinion on this app on the AOTA Checking the Pulse blog.

A HIIT Interval Timer - This app is designed for exercise, and I used it for my Couch to 5K training. But you can label each time frame however you want. I could see where you could use this in the clinic, especially for work hardening patients, or if you had some kind of circuit training setup.

Days Left Widget - This is a cute little widget for your home screen that allows you to set a countdown to different events. You can pick a picture, color, and label for the countdown. On my "exercise" screen I had countdowns to the different races I was planning for, and on my "calendar" screen I had the countdown to my vacation.

Drive - I use Google Drive a lot. This gave me quick access on the phone to my documents and I could download the most frequent to view offline as well.

Google Voice - I have a google voice number that I use as my "work number" to give out to clients and then rings my cell phone. The widget for the phone allows me to switch easily from calling with my number to calling with my voice number, sending a text, and viewing messages. 

Pocket - One of the other apps I have actually paid for. This app used to be called Read It Later. It coordinates with a browser extension on my computer. When I am browsing articles, instead of pulling a TL;DR I can press the "read later" button and it will save it to my phone for when I have time. Does not work perfectly, can't do PDFs for example, but it is one of my favorites.

Speed Anatomy Lite - this is a cute little matching quiz on body parts and names. You can't customize which ones to test, but they do make specific ones for bones, muscles, and blood vessels. Kind of fun as a review, might be good for students.

Other helpful app resources:
AOTA 'Appy April series
AOTA list of OT related apps (members-only content)
Advance Magazine Speaking of Apps
Army OT Guy's Apps for mTBI


c'mon get Appy (part I: Apple)

Editor's Note: another example of how entries go awry. I started writing this a couple years ago when I was working in the school system and had an iPad to use. Since then, there's been a multitude of new apps and developments and there are many better sites that discuss apps (I have linked some at the bottom). But read on for some of my thoughts on the apps I was able to use.

When I worked in the school system, we got iPads as part of a grant. My fellow OTs and I developed a list of all the apps we wanted, and then that list got cut to a very small number. So I didn't get to use anywhere near the number of apps that I wanted to or felt would help for work. But here are my thoughts on some of the apps that we did have access to.

IPad Apps I Have Used:
- Camera - This is standard on the IPad. I could (and probably will in the future) use it to take grasp photos. But right now, my main use is to have a large mirror. You can flip the camera to face you, which can be very motivating for some of my lower level students. I wish I could make it make a noise when it was touched but it's handy.

- Photo Booth - Also standard on the Ipad and I use basically as a mirror with a bit of fun attached due to the extra features.

- Dexteria - this app purports to be developed in conjunction with OTs. It has 3 games: Tap It, Pinch It, and Write It. Tap It requires you to place a flat hand on the screen and tap the finger that is indicated. I haven't had any kids in the preschool or the other areas I cover that have been able to get through the calibration, let alone the game itself. I find that the Write It game is too unforgiving for even my older and higher level students. Pinch It is my favorite of the games. It starts with stationary crabs, progresses to moving crabs, and then adds in visual discrimination in the color of the crabs. It can be difficult to get a perfect pinch on the crabs, and the red/green crabs aren't exactly kind to the colorblind. But it is a fun game and the kids like it. It also keeps track of the times for all the levels and you can review it later after the session, even after switching to another app.

- iWriteWords - probably my favorite app for tracing letters. It has a "connect the dot" feel as you trace the letters and short words. It was forgiving enough for most of my kids to be able to succeed, without losing the intent of the letter formation.

- Sam_Phibian - this is a really cute game that works on a lot of concepts. Little bugs of different colors fly by Sam the frog and he needs to eat the designated number of each kind. If he eats too much, he falls off his lily pad and is eaten by an alligator (implied). The bugs move in different patterns and speeds, and there are also fun things to eat that will put outfits on Sam. Kids love making Sam eat things by tapping like crazy. Following the instructions was too high level for most of my kids, but might be better for your caseload.

- KandyFish- I like this app. The music can be kind of annoying, but it is cute. In this game you can choose color matching, pattern finishing, or tracing (prewriting) games. There is also a coloring feature. I like that you can control which game to play, and skip through the prewriting shapes to get the one you want.

- AMaze Yourself- This app allows you to create mazes of different sizes and guide a mouse through to find his cheese. It's nice to have unlimited mazes that can be so easily customized but the sensitivity is very poor, so it was very frustrating for the kids to try to get the mouse on the right path. 

- Pocket Pond- we have the free version which is kind of limited in what can be added to the pond. But my low vision kids like the sound that they get for touching the screen.

- Tanganku- This game presents as having potential but didn't really pan out well for me. You're presented with multiple colored moving dots and asked to press the black ones. But the touch controls don't seem to be sensitive enough to consistently activate. And there's no way to customize the game, it progresses in speed and difficulty no matter the accuracy of the user. It uses the same pattern for each game and only lasts about a minute.

- Monkey Preschool LunchBox - I have yet to meet the child who does not like this game. There are puzzles, counting games, identifying colors, and identifying differences games all presented in rapid fire with an animated monkey dancing every time you get something right. It also lets you pick a virtual sticker for every 3-4 games done correctly.You can't pick the games or difficulty level, and there's no automatic continuing if you struggle badly on a game. But kids love this crazy monkey... it was a major reinforcer.

- Caseload Tracker - This is an app developed for SLPs to keep track of their school based caseloads, when reports are due, what their IEP goals are. I had caseloads of 80-120 kids, and was not about to tappy-type in each kid's name and goals when I already had this information elsewhere. We had an online IEP system so goals were available there, and also usually printed out in a binder for the specific school. Simple charts accomplished all this a lot easier for me. Even with the few kids I tried this out for, I didn't really find the app useful.

- Redfish- this app comes packed with a lot of additional games that may not be readily apparent in the description. There is a regular piano which will do playback of your song, as well as a funny noise piano. There are puzzle games, different activities for each letter of the alphabet, and various games to encourage understanding of cause and effect. I like the variety of games involved though some are pretty limited.

- Labyrinth LE - remember the old wooden labyrinth games with the metal ball? Super fond memories for me of my great-grandma's house. This app allows you to get the same effect on the iPad. I think you were able to choose which level to try, but I can't remember. I thought this would be a great praxis task, but it was extremely hard for my kids just to hold the board steady. Most needed HOH assist to stabilize and grade their movements.

- Tangram - This is a very basic tangram game that allows you to choose which picture you want to attempt. You can touch the pieces to drag into place. My kids had a hard time understanding how to flip the parallelogram and how to use 2 fingers to turn the pieces. You get a really cool fireworks display if you complete the puzzle, but the sensitivity is off so even when the puzzle looks complete, it doesn't register as complete.

- Injini Lite - This is a great game that I continue to recommend to iPad owners for their kids. This app offers tracing, pattern recognition, matching and some easier cause and effect activities for kids. You can choose which section to work on and it was pretty reinforcing for the kids. The full version is expensive but the lite version is a must-have.

Other helpful app resources:
AOTA 'Appy April series
AOTA list of OT related apps (members-only content)
Advance Magazine Speaking of Apps
Army OT Guy's Apps for mTBI


Pregnancy and Sensory Challenges

Pregnancy comes with many challenges... here are some weird sensory ones that I've noticed.

For many people, this is the telltale sensory experience in pregnancy. I am super sensitive to smells normally, so I figured that I'd be losing my cookies every whipstitch when I got pregnant. Fortunately I have not had that problem! But there have definitely been times when I walked away from an area that smelled like fish, or eggs, or peppers (after the kitchen fiasco in our home referred to as "the great pepper incident").
The smells that have really gotten to me are (oddly) related to clothing. Being underemployed at the point that I needed to switch from normal clothes to maternity clothes, I was not really in position to go buy a new wardrobe. Fortunately, 4 of my friends loaned or donated their items to me, saving me a lot of money and hassle. However, I wasn't really counting on the sensory experience of walking by my closet and smelling 4 different people instead of my own ignorable smell. So every middle of the night trip to the bathroom woke me up even more by the strange sensory experience.

Again, I've been very lucky in this arena. I worked with a girl last year who could predominantly only eat macaroni and cheese for the duration of her pregnancy because everything else made her sick. I really haven't had any true aversions, and very rarely anything that could be classified as a craving. But there are feelings occasionally of "I need meat" or "I need cheese" which I assume is my body's way of trying to get all the right nutrients. I used to eat very little red meat and have 1-2 "accidentally vegetarian" days per week, but that has changed considerably. Baby wants meat, so there have been quite a few burgers and roasts. The texture of meat is not something I'm really too fond of either on a normal day, and I often seek out soft foods (applesauce, pudding, yogurt) but it's been a necessary change to keep my body in balance. I've generally found that there are a lot of days when I'm just not interested in most foods, not really in the mood for anything in particular. I've eaten a lot less Mexican and Chinese food during the pregnancy, but generally eaten a lot of spicy foods.

I have found that I'm a little more sensitive to certain textures than I normally am. Long-time readers will remember my battles trying to entice myself to use lotion. My skin is much more prone to being dry (and the water exercises make it exponentially worse) but I am finding myself even less willing to use the lotions I need.
I have several issues with my clothing as well. First is the problematic issue of the change in how clothes fit seemingly from day to day. We have at least twice packed for a week-long trip only for me to find mid-week that packed clothing does not fit. Very frustrating and odd from a sensory and mental perspective.
My other major clothing issue has been wearing Ted hose (compression stockings). If you're not familiar with these, they have a hole in the bottom. Not such a big deal when I'm resting, but when I'm wearing shoes and walking around I have to consciously (and very frequently) suppress my awareness of the feeling of the hole. It's the "seams in the socks" sensation on steroids.
The final tactile issue is that of personal space. First, the baby doesn't mind taking up my space whenever he feels like it by kicking or rolling. This is a fun sensation sometimes but can be a distraction. The bigger personal space issue is that everyone and their brother feels compelled to come right up and touch you. I'm a little defensive and ticklish and prefer to have warning before touching. Not so lucky with that sometimes.

Sensory Overload
In general, with the anxiety, hormones, stress and various sensory increases, I'm just more easily overloaded than before. So this, combined with a lot of fatigue, has led to a lot of naps. Some days I come home from work and just need absolute quiet, feet up, and no stimulation at all to unwind. And many days, I spend a lot of time in bed if I'm just struggling with the overload. I have downloaded some nice relaxation apps and mp3s so that even when I can't actually sleep, I can go to my calming space and come back to an appropriate level.


OT for Hip Fracture

What can OT do for a person with a hip fracture or hip replacement? More info in the full post.
Note: this post was written several years ago but still holds true. Just be aware that surgeries and protocols are changing with time and each surgeon will have their own specifics they want followed. I worked at a facility where the surgeons preferred a 2-incision "mini" replacement that carried no precautions, and several who debate whether to use an anterior or posterior approach. Just be up to date on what is preferred by your medical team.

Often, if the hip breaks near the joint's socket, the orthopedic surgeon will perform a total hip replacement (THR). This is also a common elective procedure for individuals w/ degenerative joint disease (DJD). There have been several advances in the operation, and there are new techniques that are less invasive and don't carry hip precautions. If for some strange reason you were pushed into a room with a patient you had no information on, and wanted to know whether this patient had a THR w/ precautions or an ORIF/pinning w/o precautions, the presence of a brace that extends from ankle to groin or a giant triangular pillow attached between the legs is the flashing sign that says "YES, I HAVE PRECAUTIONS."
Don't count on the pt. to remember, as you may not have done a full cognitive eval yet, and it may have slipped even a very intact person's mind after the anesthesia.

For the sake of this example, we'll assume that our subject "M" has a THR w/ the standard precautions (no hip flexion past 90*, no crossing midline w/ operated leg, no internal hip rotation) and the fourth (no active abduction) which is used depending on the location of the fracture and the surgeon.
There will also be a note about weight bearing status. Often, a person electing to have this surgery at a younger age will be allowed to weight bear as tolerated (WBAT). If there is more concern over the stability of the joint or bones, the surgeon will want less weight on that leg. We'll assume that "M" is partial weight bearing, which means that only 50% of her weight on the operated leg. (This saves us from having to explain toe-touch WB with the uncomfortable metaphor of not crushing an egg under your foot; and from non-WB which means that you have to hop. I have done the hopping w/ several... most recently an 89 y.o. female, and progress was slow)

We'll assume that in the OT evaluation, the therapist developed an occupational profile of "M", highlighting her concerns and priorities. We won't go into that in-depth in this post, as I actually want to finish it at some point. But, from my 'chart review,' I see that "M" is an educated woman who was respected at her job and has family support. The report states that she lives in a high-rise, which is good because it probably has elevators, but could be bad if they have rules about adaptations to apartments for safety. She also has vision difficulties, which could complicate ADL retraining.

ADL retraining, or relearning how to do the basic activities of bathing, dressing, toileting, transferring, etc, will be a large part of an OT's treatment for "M." Learning and understanding hip precautions is also a major task- non-medical personnel are not likely to instantly understand hip flexion, adduction, abduction, so this is a key for the therapist to rephrase, review, and demonstrate precautions so that the patient does not forget them and does not pop their hip out. Standard hip precautions often have to be followed for 3 months, so it needs to become second nature. (I once had a gentleman w/ dementia in his 80's that could not remember and understand these. He liked to draw, so I taped paper up on the wall and had him stand and draw cartoons of people obeying hip precautions) Here's some quick ways to simplify the precautions while covering some of the contingency situations:
  • No hip flexion beyond 90*: Don't bend over! Don't try to get anything off the floor without a reacher! Don't lean forward when standing up from a chair. Use the adaptive equipment for dressing. (As a therapist, you can also help by modifying the hospital bed so that the legs don't raise. Often a little button on the foot of the bed or on the outside of a rail)
  • No crossing over midline: Don't cross your legs! Use the wedge or pillows between your legs in bed. Avoid sleeping on your side.
  • No hip internal rotation: Keep your toes pointed up in bed, don't let them turn toward each other. Don't pivot on the operated leg.
How is "M" going to get bathed and dressed independently when she can't bend over? Adaptive Equipment/Devices. A "hip kit" is often recommended, but there are cheaper alternatives to the medical supply stores. Reachers and long sponges can be found at many discount and pharmacy stores. Long handled shoe horns are found at my local Dollar Tree. (I have a handout on how to make dressing sticks, long sponges, and sock aids from household items, but I can't lay hands on it. Will link to it later.) At any rate, an OT will work w/ "M" to help her develop new patterns and procedures for doing her daily tasks w/ devices as needed.

Transfers are often looked upon as "PT territory," but an OT can't expect to work without being comfortable helping people relearning safe transfers. This includes bed to chair, as well as into the tub or shower and to the toilet. Though the "comfort height" toilets are gaining ground, most people (and much of my hospital) has the standard 15" commode. This will not be workable for most individuals w/THR. There are risers for toilet seats, but I have always wondered about their sturdiness. I recommend getting a bedside commode / 3 in 1 toilet, throwing out the catcher/hat/pot, and putting it directly over the commode. In the tub or shower, I always recommend grab bars, and then experiment with different seats to see what works best for the patient. School-based OTs work to get their kids in the least-restrictive environment, I look for the least expansive tub chair that offers the patient the level of safety they need. I have had 1 person w/ THR demonstrate a safe step-in transfer to a tub, but most people will need some sort of seat to swivel into the tub. This is not natural to people, and takes practice.

As "M" progresses through the continuum of care from acute hospital, to skilled nursing, to home health (more likely than outpatient in her case), she will continue to work on more advanced skills that she had previously engaged in, such as cooking, car transfers, showering, etc, which OTs call IADLs. Hopefully someone will be able to visit her home as she gets near to discharge so that they can advise on home recommendations. That includes placement of grab bars, moving furniture, adaptations for low vision- anything to make "M" safer and more independent.


OT Bag: Ancient Egypt

I spent last year practicing in a great school system with a terrific and experienced group of OT practitioners. One of the ideas that they had is that each person creates a themed bag of activities, which you keep for a week and then pass on. It's great, since you get 2 months worth of activities for just developing one plan. This is what was in a bag I created for April/May on Ancient Egypt.

I really enjoyed learning about Ancient Egypt when I was young, entertaining (briefly) the notion of being an archaeologist and code cracker and discovering long forgotten things. I thought it would be a good topic for our kids, in an adapted way. My interest was renewed when I found this great book on sale at Ollies for $4:

It came with these nifty hieroglyphic stamps and phonetic instructions so you can make words. This would have made a great cotreat with a speech therapist because sounding out the letters for their names was really hard for most kids. Usually, I would circle on the sheet which stamps were needed instead of having the kid determine whether they had a short or long vowel in their name or a SH instead of an S. It was still a visual perceptual challenge for the kids to scan among the stamps for the correct pieces.

I included other items so that there was variability for ages and activities needed to achieve goals. There were Egyptian "medallions" in bird shape on card stock to practice cutting and tying; coloring sheets that could be used with pyramid crayons; and a pyramid that required cutting, folding and taping to construct. 
We had a game at the office that requires you to move a marker through a maze using a magnet underneath the maze board.

Some of the items that I included didn't work out as well. I made my own cryptogram about King Tut on a website, but failed to notice that there weren't many letters that repeated, so it was very laborious for the kids. I had pages on complete and incomplete Pascal's Triangles (I enjoy dorky math type things) for kids to do simple addition and color in the even and odd numbers with different colors (try it, it makes a pattern!). However, even the older kids I worked with struggled mightily with the simple addition concepts and did not know odds/evens, so this did not go anywhere. The complex folding and taping required for the pyramid construction was also pretty hard for most. However, judging by what I read on other blogs and the IEPs I saw from other districts, I think that my kids on caseload (who were being mainstreamed) were generally lower functioning than  others getting OT, so these items may work for you with your kids in a graded manner.

Overall, I enjoyed making this bag and trying to instill a little love for learning about ancient Egyptian culture with my kids, though it didn't necessarily work out as planned.  


Salary, Hourly, and Contract- understanding different types of employment

Occupational therapy is a great field with so many opportunities to work with different populations and in different settings. I always tell students that you have such flexibility that you can literally work as much (or as little) as you want. If I could have cloned myself a couple of months ago, I would have been able to work 80 hours a week. The other side of the coin is that I also now work only 2 days a week and still have financial security. To navigate this world, it is helpful to know the different types of employment that are available. Here are some descriptions and pros/cons to different types of employment.

Salaried employment is what most people think of with a "typical" job. You are paid a set amount per year and usually after a short probation period have an expectation of job security. Promotions may be available more readily, and most management positions are also salaried. Typically, you can negotiate for a raise at your annual review and may get a cost of living raise during this period as well. Salaried workers usually get benefits such as health insurance, life insurance, paid vacation days, and 401K eligibility/matching. CPR and other necessary certifications may be provided and reimbursed at your employer. Continuing education may be reimbursed and days off for education may also be paid. In an OT world, you may need to spend extra time outside of "typical" hours doing work tasks. There may be meetings during lunch times and you may need to stay late to see patients or do paperwork. There may be additional job responsibilities (the infamous "other duties as assigned") like participating in committees, representing the facility at meetings, etc.

Hourly employees may make more money than salaried employees and may be able to opt out of purchasing certain benefits in order to increase their pay. Part time employees will often be paid hourly .Typically, you will not be asked to work overtime because then you will be paid more, and bosses try to avoid that sort of thing. :) You will likely have to keep very close track of your time in, time out, and lunch times to ensure that you are paid accurately. Hourly OTs may still earn paid time off, but will accumulate it gradually as they work each hour. Depending on the employer, hourly employees may not be guaranteed a certain number of hours each day or week, and may also be the first person "furloughed" if someone is looking to cut costs.

Contract employees will likely make more money than salaried or hourly employees, but they are even more costly to the employer than it would seem from that knowledge. If there is a contract company, they are getting paid an extra fee from the facility for that employee. It's a very expensive proposition. It's important to remember that if this facility had any other options other than hiring a contractor (also known as a traveler) that they would have taken it long ago to save money. So there is a potential that you could be walking into a bad situation in one way or another, although you may also just be covering for an extended leave such as a maternity, sabbatical, or medical leave. As a contractor or traveler, all you are getting from the facility is your money. There will be no trainings, no benefits, and they're not going to want to have you taking many days off. You may be able to get these benefits through your contract company, they may also provide relocation assistance. If you have a continuing relationship with them, your contract company will do the heavy lifting of actually finding you placements instead of you looking for job after job, and will help you get through licensing procedures as needed. It's also a good way to see new areas of the country and a variety of practice areas. From the viewpoint of the facility, they will want you to be able to hit the ground running, maintain a higher productivity, and function without assistance. If there's a rehab tech, they are probably helping someone else. If there's a difficult patient, they might be on your caseload. If there's something else that needs done, it may well be shuffled to your schedule. You will be guaranteed a certain number of hours per week, likely for a set time period of a few months to a year. This is often not a good fit for a new graduate who may need more support starting out and is still learning the field. This can certainly be a full-time long-term gig if you live in a metro area or are willing to travel, but there is a degree of insecurity between placements. Contract companies vary with how much they require their employees to do above the actual OT work, as well as what benefits and placements they provide. In an odd twist, some facilities actually employ their entire therapy staff through a contract company instead of having on-site management and hiring. In this case, you operate more as an hourly employee.

Working prn (as needed) or OPT (occasional part-time) involves hourly pay at a high rate like a contractor. You may have a higher productivity standard and will likely not get very much assistance from the staff (both because you're expected to operate independently and because people won't know you as well). Your employers will want you to spend your time efficiently, and so you won't likely be asked to go to meetings or rounds. Similar to contract employment, you are filling a shortage. There is no guarantee of hours per week or continued employment from one day to the next. If you are with a large system such as a brand of nursing homes or hospitals with multiple facilities, you can get frequent calls and make it work as a prime gig, but it's a risky move. This is much better as an option for moonlighting. Many school system OTs have a prn job for summers or weekends to supplement their other pay. Again, this is rough to do as a new graduate (especially if you're balancing multiple facilities or different practice areas) and since you're not going to get staff support, you need enough experience to be independent with what's being asked of you.

There's a lot of flexibility in OT employment and knowing these options can help you make decisions on the jobs that are out there. Check out the "students" label and some of the Greatest Hits entries if you are curious about other facets of finding your OT job.


Keeping Organized

I was lucky enough to be invited to contribute to a couple of OT Month pieces. One was on Abby's awesome pediatric OT blog and the other was for AOTA. In these, I shared some of the organizational tips that I use to try to keep life together. Here is a more elaborate and visual demonstration of some of the best.

My dad teaches high school seniors and as part of his unit on college prep always advises that the kids keep 2 calendars- one for the whole semester and another for the coming 4 weeks. I found this magnetic dry erase calendar at Sam's Club back in 2003 (?) for about $8 and have been using it religiously ever since. I only have to update a week at a time and get to use all the different color markers for coordination. It lives on the fridge and helps keep everything straight.

My high-tech method for the calendar is using Google Calendar, which I'm sure comes as no surprise to anyone who knows of my Google product allegiance. I love that it's integrated with my phone and google account on the cloud. Also, it's easy for my husband and I to add things to each other's calendars so we stay updated, and I can add additional calendars (WVU sports!) so I have other events automatically on my schedule. 

I love these accordion files for organizing all my different papers. I have 3 that I use for different collections of stuff. This one is labeled to keep track of my continuing education for the past five years (required in case of audit in my state), my various licenses, and papers needed for my early intervention renewals.

I got this finance organizer at the dollar store to keep track of my receipts so that I actually had them come tax time. I didn't write in the amounts because I want to reuse it and keep track of all my finances on a computer spreadsheet. You could also use a small coupon file for this same purpose.

In a super-useful variation of the accordion file, this one is broken down for all the days of the month. Especially beneficial when I was in the school system last year as I could place several copies of the relevant evaluation, a prior written notice, and a blank sheet for notes clipped together on the day for the IEP meeting. When I would get an email asking me to screen a child, I could throw the screening papers in the folder on the day I would next be in the school. Very handy when you have multiple sites to coordinate. I got this idea from the book Getting Things Done, which is the only productivity book that I've ever read and very useful.

Speaking of Getting Things Done, one of my favorite apps is Due Today which is based on the methods outlined in the book. You can check out my interview with Stephanie Yamkovenko on the AOTA website to see all the reasons I love this app (one of only a mere handful that I have actually paid for). On the shot, you can see that I have different priority colors, due dates, overarching projects (lots to do in the "baby" category, obvs), contexts, etc. I don't have any notes for these but they are helpful too. Subtasks also help to break up the large pieces and figure out what to do first- you can see that I need to get a cream colored shirt but only if the coral skirt fits. 

Do you have any great methods to stay organized that work well for your business or family? Feel free to share in the comments!