3.5 y.o. child w/ SPD (who rarely talks) is distracted by the stinkbugs in the clinic room.
"Goodness gracious! Look at the buggies!"
followed by...
"If my dad was here, we'd open up a can of whup-ass on those stinkbugs!"
They continue to surprise and exhaust me...
10.14.2008
10.13.2008
seesaw
There is such a seesaw pattern in much of life, but in this job in particular. We have busy days, slow days, few kids, many kids. Ups and downs and all arounds.
We have a speech therapist now, which is excellent. I look forward to not being responsible for all the communication boards needed in the hospital, and to getting my kiddos the treatment they have been waiting for.
The insanely busy SNF floor and acute care floors have calmed down a bit, at least for a few days. Nice to have less on my plate for the mornings since they are short and the evenings are long with kids. The elderly lady w/ thalamic stroke from this post has now landed down my hallway... she is doing considerably worse since acute care, sadly. We played cards today and I was happy that she had moments of understanding and initiating action on her own.
Laid down a VERY hard line with a pt. the other day... he has been quite uncooperative since his arrival and keeps insisting that he's independent or will be independent soon without assist. 2 weeks ago I needed to reevaluate how close he was to meeting his goals and needed to see him don shirt and pants on a Friday afternoon. "I don't need to do that, I'll do that when I go home." I basically said, "prove it." We stood w/ MAX Ax2 for 3 seconds, which was not enough time for him to pull his pants up, but was (I thought), enough time for him to realize that he needed to work on ADL tasks. Gave him a brief talk about how he needed to keep working... it didn't take. He made the COTA cry when she was trying to work with him. So, when I came back to that little mess, I said, "Mr. B, you made the other girl very upset, and I have to tell you that she's the nicest person on staff. Now you're stuck with me. You can pick which chair you sit in and where it is in the room, you can pick out which pair of pants you're wearing, but you will sit up and get dressed, and you will not get rid of me until that is done." His son was skeptical, but proud that his dad was able to do so much for himself. Saw him again today and he had a much better attitude about the whole thing, and is now a CGA w/ LE dressing.
New kid eval tomorrow... tried to do a Peabody on my fresh eval from last week and he was a total terror today. His mom about cried when I gave her the report on his behavior. She has some majorly off-base assumptions about his development as well, thought that his FMC was at normal developing range and reported that he "graduated" from speech therapy. I suspect that he "graduated" because he ran out of visits under medicaid, b/c his main statements of "I tell mom" and "you not my friend no more" were not age appropriate. He has sensory and behavioral issues (always a combo) and he will be a considerable challenge.
Get to go w/ my PT coworker to a Civitan Club meeting to explain our grant request for some new equipment and supplies. Fingers crossed for support in an expedited fashion!
We have a speech therapist now, which is excellent. I look forward to not being responsible for all the communication boards needed in the hospital, and to getting my kiddos the treatment they have been waiting for.
The insanely busy SNF floor and acute care floors have calmed down a bit, at least for a few days. Nice to have less on my plate for the mornings since they are short and the evenings are long with kids. The elderly lady w/ thalamic stroke from this post has now landed down my hallway... she is doing considerably worse since acute care, sadly. We played cards today and I was happy that she had moments of understanding and initiating action on her own.
Laid down a VERY hard line with a pt. the other day... he has been quite uncooperative since his arrival and keeps insisting that he's independent or will be independent soon without assist. 2 weeks ago I needed to reevaluate how close he was to meeting his goals and needed to see him don shirt and pants on a Friday afternoon. "I don't need to do that, I'll do that when I go home." I basically said, "prove it." We stood w/ MAX Ax2 for 3 seconds, which was not enough time for him to pull his pants up, but was (I thought), enough time for him to realize that he needed to work on ADL tasks. Gave him a brief talk about how he needed to keep working... it didn't take. He made the COTA cry when she was trying to work with him. So, when I came back to that little mess, I said, "Mr. B, you made the other girl very upset, and I have to tell you that she's the nicest person on staff. Now you're stuck with me. You can pick which chair you sit in and where it is in the room, you can pick out which pair of pants you're wearing, but you will sit up and get dressed, and you will not get rid of me until that is done." His son was skeptical, but proud that his dad was able to do so much for himself. Saw him again today and he had a much better attitude about the whole thing, and is now a CGA w/ LE dressing.
New kid eval tomorrow... tried to do a Peabody on my fresh eval from last week and he was a total terror today. His mom about cried when I gave her the report on his behavior. She has some majorly off-base assumptions about his development as well, thought that his FMC was at normal developing range and reported that he "graduated" from speech therapy. I suspect that he "graduated" because he ran out of visits under medicaid, b/c his main statements of "I tell mom" and "you not my friend no more" were not age appropriate. He has sensory and behavioral issues (always a combo) and he will be a considerable challenge.
Get to go w/ my PT coworker to a Civitan Club meeting to explain our grant request for some new equipment and supplies. Fingers crossed for support in an expedited fashion!
10.10.2008
Busy busy busy
been running around a lot lately... 2 weekends traveling in a row coming up, busy census at the hospital, and 6 OT practice magazines just piling up on my reading list. I also have to prep for girl scouts since I have another kid eval and will miss the meeting. I will update again... someday!
10.02.2008
brief update note
Some updates...
After a long fought afternoon, I finally managed to get the cut links to work so I can shorten posts. The 6 subscribers from google reader will still have to deal w/ walls of text, but the rest of you got life a little easier. I don't think that I'm going to go and retro-edit the other posts, they'll be off the main page in a few weeks anyway.
Also, I think I am going to start uploading things to google documents for file sharing, since it doesn't require an account and there hasn't been any outcry from the OT Advantage community begging for files over there. (Yes, I recognize google's domination over my internet life, and I'm ok with that)
Now I just wish there was a way to make it so that when you clicked on the tag link (like "students") that it would show you the titles of the posts instead of all the relevant posts. I am somewhat of an organization freak. A free internet cookie to the one who figures out how to do that, and writes it in a way I can understand.
After a long fought afternoon, I finally managed to get the cut links to work so I can shorten posts. The 6 subscribers from google reader will still have to deal w/ walls of text, but the rest of you got life a little easier. I don't think that I'm going to go and retro-edit the other posts, they'll be off the main page in a few weeks anyway.
Also, I think I am going to start uploading things to google documents for file sharing, since it doesn't require an account and there hasn't been any outcry from the OT Advantage community begging for files over there. (Yes, I recognize google's domination over my internet life, and I'm ok with that)
Now I just wish there was a way to make it so that when you clicked on the tag link (like "students") that it would show you the titles of the posts instead of all the relevant posts. I am somewhat of an organization freak. A free internet cookie to the one who figures out how to do that, and writes it in a way I can understand.
Case Example with Goals
A review of "recent keyword activity" leading to the blog indicates that there's a lot of people out there looking for example goals and treatments for different diagnoses. I'll try to do some posts in this direction, please don't plagiarize them for your school assignments.
Here's a walkthrough case to see the clinical reasoning behind the goals that are written, and a few example goals.
CASE: Mr. X is a 65 y.o. s/p THR on the acute orthopedic floor. He lives alone, has a tub/shower, and was previously independent with all I/ADLs. He would like to return to full independence.
SETTING BACKGROUND: Heads up- in an acute hospital, your basic joint replacement patients w/o significant comorbidities or post-op complications will leave the floor in 3-5 days. Case management will look to therapy to determine where this person will go (home, SNF, acute rehab). The lack of time for intervention means that your treatments need to cut to the point, so you can give an accurate expectation of how the client will perform in the continuing days, and whether they must have continuing care.
IMPORTANCE: Goals at this level of care have to reflect the quick pt. turnover. What are the most important things for Mr. X to learn and demonstrate before he discharges to maximize his safety and independence?
My ranking: hip precautions; basic mobility; LE dressing; advanced mobility (tub transfer, standing tolerance); home safety. Your clinical reasoning may place importance in a different order, here is my reasoning. He must know hip precautions before moving, to prevent dislocation and repeat surgery. He must be able to stand and take at least 1-2 steps so that at the very least he can get from w/c to BSC, and to facilitate dressing. We have no evidence from our brief case that this man would have any difficulty w/ UE dressing, but he cannot be independent unless ADL retraining is performed for LE dressing. He needs to be able to put on pants and shoes, or he is not going to have anything resembling independence upon discharge. At the point that he can stand up long enough to put pants on, he is probably ready to progress to advanced mobility, and I consider tub transfers to be especially important. It's better to review this in a controlled environment before the pt. goes home and decides to do it anyway. And home safety is always a good thing to work on with your patient, to try to prevent falls and maximize independence. If you, like me, do not get to leave the hospital to investigate the home, you will have to get creative with this.
GOALS
In 3-5 visits, pt. will...
1. verbalize and demo 3/3 hip precautions (we are assuming he doesn't have the extra 'no active abduction' precaution)
2. transfer to BSC w/ CGA and assistive device
3. don socks w/ sock aid independently
4. don pants w/ AE prn and CGA (I almost always use the "AE prn" phrasing since different devices work better for different people, and I have actually seen a person don pants independently w/o any device while observing hip precautions)
5. perform safe tub transfer to extended TTB w/ CGAx1
6. verbalize/demo 3-5 home safety techniques
The best way to get better at writing goals and treatment plans is to practice and get feedback from a trusted advisor- professor, supervisor, etc. The best exercise I know for this is detailed in this simple document. I have not completed an example there as this was an assignment from one of my teachers, and surely others are using it as well.
Here's a walkthrough case to see the clinical reasoning behind the goals that are written, and a few example goals.
CASE: Mr. X is a 65 y.o. s/p THR on the acute orthopedic floor. He lives alone, has a tub/shower, and was previously independent with all I/ADLs. He would like to return to full independence.
SETTING BACKGROUND: Heads up- in an acute hospital, your basic joint replacement patients w/o significant comorbidities or post-op complications will leave the floor in 3-5 days. Case management will look to therapy to determine where this person will go (home, SNF, acute rehab). The lack of time for intervention means that your treatments need to cut to the point, so you can give an accurate expectation of how the client will perform in the continuing days, and whether they must have continuing care.
IMPORTANCE: Goals at this level of care have to reflect the quick pt. turnover. What are the most important things for Mr. X to learn and demonstrate before he discharges to maximize his safety and independence?
My ranking: hip precautions; basic mobility; LE dressing; advanced mobility (tub transfer, standing tolerance); home safety. Your clinical reasoning may place importance in a different order, here is my reasoning. He must know hip precautions before moving, to prevent dislocation and repeat surgery. He must be able to stand and take at least 1-2 steps so that at the very least he can get from w/c to BSC, and to facilitate dressing. We have no evidence from our brief case that this man would have any difficulty w/ UE dressing, but he cannot be independent unless ADL retraining is performed for LE dressing. He needs to be able to put on pants and shoes, or he is not going to have anything resembling independence upon discharge. At the point that he can stand up long enough to put pants on, he is probably ready to progress to advanced mobility, and I consider tub transfers to be especially important. It's better to review this in a controlled environment before the pt. goes home and decides to do it anyway. And home safety is always a good thing to work on with your patient, to try to prevent falls and maximize independence. If you, like me, do not get to leave the hospital to investigate the home, you will have to get creative with this.
GOALS
In 3-5 visits, pt. will...
1. verbalize and demo 3/3 hip precautions (we are assuming he doesn't have the extra 'no active abduction' precaution)
2. transfer to BSC w/ CGA and assistive device
3. don socks w/ sock aid independently
4. don pants w/ AE prn and CGA (I almost always use the "AE prn" phrasing since different devices work better for different people, and I have actually seen a person don pants independently w/o any device while observing hip precautions)
5. perform safe tub transfer to extended TTB w/ CGAx1
6. verbalize/demo 3-5 home safety techniques
The best way to get better at writing goals and treatment plans is to practice and get feedback from a trusted advisor- professor, supervisor, etc. The best exercise I know for this is detailed in this simple document. I have not completed an example there as this was an assignment from one of my teachers, and surely others are using it as well.
10.01.2008
notes from the listserv
As an AOTA member, I subscribe to a couple of special interest listservs in an effort to get smarter semi-randomly. Yet, I often want to unsubscribe for one of two reasons:
1. Failure to observe internet/listserv etiquette. Perhaps I'm a spoiled person, having had internet access since I was 10, but there are some basic rules that people should observe online when their words come into my sphere. Please!!! Don't type in caps! Use a subject in your emails! Send a direct reply to the sender if your message does not contribute to the entire discussion (e.g. "thanks" or "can you send that to me too?").
2. OT Trolls. Yes, they exist. They seize on an opportunity to argue, in detail, about whether Person A is doing OT, what the difference between OT and PT is, whether the original poster was being a good OT or not... ad nauseum. I've wondered about suggesting that a new listserv be created just so that people can keep their biased partisan arguments about OT ("OT's can't walk people! That's PT!" vs "It's better to walk them than to do a stupid craft or game!") somewhere else. Perhaps I wouldn't be so irritated about this fight about the OT domain if we didn't have a practice framework that detailed an outline for therapy, or if this exact same fight didn't already happen a few months ago when the last RA motions were up for debate, or if it didn't all look suspiciously like one person stirring the pot in an effort to get more attention to their website and ideas.
An open call to stop this foolhardy "debate" if you can call it that. Functional mobility is part of the OT practice act. Enabling and Prepartory activities are part of our treatment framework. Crafts and games are at the foundation of the profession from the Reconstruction Aides. All of the arguers are right. And wrong, because limiting your practice to only one of these areas is not OT either. OT is a beautiful profession because at its core is the belief that engagement in meaningful occupation will promote health. Don't limit yourself as a practitioner, or you will limit us all, and our clients.
1. Failure to observe internet/listserv etiquette. Perhaps I'm a spoiled person, having had internet access since I was 10, but there are some basic rules that people should observe online when their words come into my sphere. Please!!! Don't type in caps! Use a subject in your emails! Send a direct reply to the sender if your message does not contribute to the entire discussion (e.g. "thanks" or "can you send that to me too?").
2. OT Trolls. Yes, they exist. They seize on an opportunity to argue, in detail, about whether Person A is doing OT, what the difference between OT and PT is, whether the original poster was being a good OT or not... ad nauseum. I've wondered about suggesting that a new listserv be created just so that people can keep their biased partisan arguments about OT ("OT's can't walk people! That's PT!" vs "It's better to walk them than to do a stupid craft or game!") somewhere else. Perhaps I wouldn't be so irritated about this fight about the OT domain if we didn't have a practice framework that detailed an outline for therapy, or if this exact same fight didn't already happen a few months ago when the last RA motions were up for debate, or if it didn't all look suspiciously like one person stirring the pot in an effort to get more attention to their website and ideas.
An open call to stop this foolhardy "debate" if you can call it that. Functional mobility is part of the OT practice act. Enabling and Prepartory activities are part of our treatment framework. Crafts and games are at the foundation of the profession from the Reconstruction Aides. All of the arguers are right. And wrong, because limiting your practice to only one of these areas is not OT either. OT is a beautiful profession because at its core is the belief that engagement in meaningful occupation will promote health. Don't limit yourself as a practitioner, or you will limit us all, and our clients.
9.30.2008
Predictions
Everyone makes predictions. Doctors give a prognosis, based on how they think the pt. will heal. Therapists set goals, which they believe the pt. will achieve in a set period of time with skilled intervention. This is part of the professional's training, and if they are not reasonably accurate with their predictions, they will not be very respected by their peers or able to do the job as well. (sidenote- it is perfectly reasonable as a student to not make these predictions very well. it is all about developing experience, understanding reasonable expectations, understanding probability, creating new schemas, etc)
So we all make predictions about our patients. These can be helpful- if you predict that your pt will not use AE at home, it's helpful to plan your interventions otherwise. Sometimes they cause us to be jaded about our patients or their capabilities. Right now, I have a pt on the skilled floor that the general consensus prediction is that she is going to die. Soon. She's 92 s/p hip fx & ORIF (thank goodness that she doesn't have hip precautions). MAX Ax2 for anything resembling mobility, during which she moans and cries. She won't eat anything except pudding/applesauce to take her pills. She has a distension the size of my fist, protruding from her abdomen. She has been talking to her deceased relatives. Unable to don a button-up sweater due to weakness and confusion. Medically, her H&H is quite low, but she has religious objections to blood transfusion. I seriously worry every time I see her that she will die while I am there. Sometimes joint replacements and orthopedic surgeries can be the beginning of the end for a person, which is awful. A few months ago, a Mrs H had a second TKR which started her downward spiral... last time she was on her feet was on our skilled floor. I hate to watch people go downhill, I hate to know that there's nothing I can do, I hate that I don't know more medical information so that I could understand what is causing the decline and fix it!
Predictions can be quite depressing... maybe it's better sometimes to just not worry about the future.
So we all make predictions about our patients. These can be helpful- if you predict that your pt will not use AE at home, it's helpful to plan your interventions otherwise. Sometimes they cause us to be jaded about our patients or their capabilities. Right now, I have a pt on the skilled floor that the general consensus prediction is that she is going to die. Soon. She's 92 s/p hip fx & ORIF (thank goodness that she doesn't have hip precautions). MAX Ax2 for anything resembling mobility, during which she moans and cries. She won't eat anything except pudding/applesauce to take her pills. She has a distension the size of my fist, protruding from her abdomen. She has been talking to her deceased relatives. Unable to don a button-up sweater due to weakness and confusion. Medically, her H&H is quite low, but she has religious objections to blood transfusion. I seriously worry every time I see her that she will die while I am there. Sometimes joint replacements and orthopedic surgeries can be the beginning of the end for a person, which is awful. A few months ago, a Mrs H had a second TKR which started her downward spiral... last time she was on her feet was on our skilled floor. I hate to watch people go downhill, I hate to know that there's nothing I can do, I hate that I don't know more medical information so that I could understand what is causing the decline and fix it!
Predictions can be quite depressing... maybe it's better sometimes to just not worry about the future.
9.25.2008
Very busy days
7 evaluations yesterday, 1 full blown ADL, and 5 other short treatments. What a day.
It was most difficult because many of the evals were complex. Allow me to demonstrate...
My ADL was with Mr. A, a pleasant, but lonely gentleman admitted w/ CHF and COPD. He doesn't want to go home w/ O2, but right now is struggling to do anything without it. We worked w/ the pulse oximeter on doing short bursts w/o the O2. His O2 cord wasn't long enough to go into the bathroom, and the nurses were saying that he'd only been using the O2 intermittantly over the weekend. However, an O2 % rating in the 70s (should be 90% or above) after a trip to the bathroom warranted getting after the nurses to get him a longer cord. The hour moved very slowly due to rest breaks as he rollercoastered up and down the O2 saturation levels. He is getting better w/ energy conservation techniques. I was a little depressed because the nurses were talking about him going downhill and that he was going to "go quick, when his time comes." I hope he can get better and also go home to a better situation.
Peds practice is picking up again. Getting another few evals and busier evenings. The peds + girl scout tuesday combination is getting hard on me... still working on finding a balance.
It was most difficult because many of the evals were complex. Allow me to demonstrate...
- L TKA. Very basic. Started off in pain and then walked into the hallway. No problem to write up, will likely go home from acute care.
- 95 y.o. thalamic CVA. A very unreliable historian. She understood yes/no only. Once to the EOB, however, she did jump up with a walker and head right out the door. (sidenote- physical recovery almost always comes quicker than cognitive recovery. Frustrating, and potentially dangerous. Reminds me of a TBI story)
- Frontal lobe CVA. Dysarthria, flaccid RUE. Frustrated at not being able to communicate with nurses and dietary staff. Promised her a communication board, which I really didn't have time to make that day, but she really needed.
- Pneumonia w/ complications that landed pt. in the ICU. Some minimal spontaneous movement w/ agitated, but not able to respond to commands. Just extubated that a.m., so no comment from the pt.
- Elderly man w/ THR after falling. No memory of hip precautions. No social support system. We were able to stand at the EOB w/ MAX Ax2 for a minute or two, but that was it. Usually at this many days out from surgery, a pt. can at least walk to a chair.
- R TKR that I knew from acute care. An interesting case, as she is able to do many of the basic functional tasks that are required by OT before discharge. However, she has very little knee flexion, and it is always a PT goal that a pt. have at least 90* knee flexion after surgery. It's a strange part of the OT/PT relationship, as I'm not grabbing legs and bending them, but it won't matter how "functional" she is if she has to get a surgery redone.
- The last of the day transferred from another hospital and was quite exhausted. Pneumonia, GI Bleed, Renal Failure. He's super weak.
My ADL was with Mr. A, a pleasant, but lonely gentleman admitted w/ CHF and COPD. He doesn't want to go home w/ O2, but right now is struggling to do anything without it. We worked w/ the pulse oximeter on doing short bursts w/o the O2. His O2 cord wasn't long enough to go into the bathroom, and the nurses were saying that he'd only been using the O2 intermittantly over the weekend. However, an O2 % rating in the 70s (should be 90% or above) after a trip to the bathroom warranted getting after the nurses to get him a longer cord. The hour moved very slowly due to rest breaks as he rollercoastered up and down the O2 saturation levels. He is getting better w/ energy conservation techniques. I was a little depressed because the nurses were talking about him going downhill and that he was going to "go quick, when his time comes." I hope he can get better and also go home to a better situation.
Peds practice is picking up again. Getting another few evals and busier evenings. The peds + girl scout tuesday combination is getting hard on me... still working on finding a balance.
9.20.2008
OT WebGems- Aging Edition
HOO-HA, I am nearing the end of my blog-related bookmarks (for now)! This edition focuses on those who are lucky enough to become elderly, with one crazy note thrown in at the end.
Architectural Updates- I have some links about aging-in-place and universal design on the sidebar, as it was the original reason I got into OT. Here's a retirement community that has incorporated some of those principles to help their residents live more independently.
Retirement Communities- The later pages in this article offer some great questions to ask before choosing an over-55, assisted living, or continuing care facility.
Balance- Here's some info and products to improve balance at any age! We should probably all start now, since our proprioceptive system starts declining around age 12.
Cognitive- As high tech pushes devices to boost your cognition and keep your mind sharp, people continue to wonder about what long-term effects all those crosswords, sudokus, and Brain Age games have.
Unrelated-- I saw a video of this car on Disaboom, and had to share. I am not a claustrophobic person, but this makes the Smart Car look spacious. However, I support the idea that a wheelchair user could have relatively easy access to their local area. I see a disproportionate number of pedestrians along high-speed roadways driving scooters than walking, and an enclosed way would be safer. I give you- Kenguru! Arriving in England soonish, US... another 15 years?
Architectural Updates- I have some links about aging-in-place and universal design on the sidebar, as it was the original reason I got into OT. Here's a retirement community that has incorporated some of those principles to help their residents live more independently.
Retirement Communities- The later pages in this article offer some great questions to ask before choosing an over-55, assisted living, or continuing care facility.
Balance- Here's some info and products to improve balance at any age! We should probably all start now, since our proprioceptive system starts declining around age 12.
Cognitive- As high tech pushes devices to boost your cognition and keep your mind sharp, people continue to wonder about what long-term effects all those crosswords, sudokus, and Brain Age games have.
Unrelated-- I saw a video of this car on Disaboom, and had to share. I am not a claustrophobic person, but this makes the Smart Car look spacious. However, I support the idea that a wheelchair user could have relatively easy access to their local area. I see a disproportionate number of pedestrians along high-speed roadways driving scooters than walking, and an enclosed way would be safer. I give you- Kenguru! Arriving in England soonish, US... another 15 years?
9.17.2008
Danger Zone Sports
Title LGT an article on the hidden injuries in cheerleading. Bonus points for the author, as the main character overcame years of physical therapy to become a physical therapist.
My mom used to work in vocational rehab and would always cross off cheerleading and football on my high school physical forms so that I couldn't participate in those. Same reason that ATV riding and some other typical fun teenager things were verboten. High risk of SCI and/or TBI. Since I had followed other paths, these forbidden activities weren't high on my interest checklist anyway. But, I did enjoy diving, and loved to do so at every opportunity. I did a lot of flips and acrobatics, at least as acrobatic as someone with no gymnastics training or natural grace. I had an incident where I hit the bottom of a hotel pool hard with both feet and jarred my whole back... thought I was going to have a serious problem but walked away from it. I dove into a friend's pool that was 2 feet shallower than I expected and scraped everything but my head on the bottom.
But even though my mom had always discouraged dangerous activity, and afterwards I always resolved to be more careful diving, the danger never sunk in until I became a lifeguard. That's when I got all the information about exactly every way you could hurt yourself in a pool, and how badly. Simultaneously, I learned that those who are being paid to protect your safety may or may not act appropriately to maximize your recovery. One little shake while putting you on the backboard, not stabilizing the head properly when retrieving someone from the bottom of the pool... there's a million opportunities to screw up. It ruined diving for me, and also ruined being a bystander. I hate to be at a public pool or riverside that's out of control... I don't want to feel responsible to help when the inevitable (to my jaded eyes) accident occurs.
I don't know how to best decrease injuries in kids who play sports, but I do think that you need a combination of parental interference and personal education. Parents can insist on safety measures for the child or team, and can ingrain good habits in kids (like seat belts and helmets). Until the child recognizes that yes, they can get hurt and need to be careful, there has to be a parent or responsible adult to step in and insist on safety.
My mom used to work in vocational rehab and would always cross off cheerleading and football on my high school physical forms so that I couldn't participate in those. Same reason that ATV riding and some other typical fun teenager things were verboten. High risk of SCI and/or TBI. Since I had followed other paths, these forbidden activities weren't high on my interest checklist anyway. But, I did enjoy diving, and loved to do so at every opportunity. I did a lot of flips and acrobatics, at least as acrobatic as someone with no gymnastics training or natural grace. I had an incident where I hit the bottom of a hotel pool hard with both feet and jarred my whole back... thought I was going to have a serious problem but walked away from it. I dove into a friend's pool that was 2 feet shallower than I expected and scraped everything but my head on the bottom.
But even though my mom had always discouraged dangerous activity, and afterwards I always resolved to be more careful diving, the danger never sunk in until I became a lifeguard. That's when I got all the information about exactly every way you could hurt yourself in a pool, and how badly. Simultaneously, I learned that those who are being paid to protect your safety may or may not act appropriately to maximize your recovery. One little shake while putting you on the backboard, not stabilizing the head properly when retrieving someone from the bottom of the pool... there's a million opportunities to screw up. It ruined diving for me, and also ruined being a bystander. I hate to be at a public pool or riverside that's out of control... I don't want to feel responsible to help when the inevitable (to my jaded eyes) accident occurs.
I don't know how to best decrease injuries in kids who play sports, but I do think that you need a combination of parental interference and personal education. Parents can insist on safety measures for the child or team, and can ingrain good habits in kids (like seat belts and helmets). Until the child recognizes that yes, they can get hurt and need to be careful, there has to be a parent or responsible adult to step in and insist on safety.
Sharing Time!
Karen suggested that I share some of the handouts and treatment tools that I had worked on over the past year. I have been meaning to upload some handouts to some neutral site that would hold them nicely for others... haven't decided on the best method for this. Some text files could be posted to Google Documents, but it won't hold pdf files... OT Advantage also holds files but I'm unsure of a space restriction and it requires a (free) membership. Thoughts?
So, until I have a go-to site for file sharing, here are some of the other things on my list that don't require seeing the actual file. One thing that I did that was sorely needed by the clientele was creating Spanish handouts. I took Spanish, but I don't know enough to actually write it. But a 2-second internet search yields several sites that allow you to enter a paragraph or more of text and get an instant translation. So, I was able to translate several existing handouts in 10 minutes, which is very handy.
In a variation of a project I did for fieldwork, I collected a bunch of medicine bottles with various opening mechanisms for people to practice functional hand skills, and contained it nicely so that it could easily be taken to any room in the hospital. Another easy thing that I did during a slow day at work was to compile fine motor kits. We already had a handout and several existing supplies, but it just took time to do. Another activity that requires only time was cleaning out our supply closet. Just figuring out what we owned saved us money- we had 10 top quality walker bags just collecting dust!
Another easy project completed out of already existing materials was to create a pill sorting activity. We had dozens of colored beads in a small container and pill boxes (and also medicine bottles from my previous project). So I made a small chart with days of the week and the numbers and colors of beads for that day. It's a combined fine motor and cognitive activity. For a higher level client, I used a medication chart (made up by a pharm student) and correlated each real medication with a color of bead.
Something that I didn't put on my annual review sheet, but try to do, is just to fill in and be useful where needed. Paperwork, fixing things, doing the small tasks can have a positive impact on your coworkers. Sewing a button back on the Peabody kit during lunch got me a great review from the OT I job shadowed. The little things can make a big difference :)
So, until I have a go-to site for file sharing, here are some of the other things on my list that don't require seeing the actual file. One thing that I did that was sorely needed by the clientele was creating Spanish handouts. I took Spanish, but I don't know enough to actually write it. But a 2-second internet search yields several sites that allow you to enter a paragraph or more of text and get an instant translation. So, I was able to translate several existing handouts in 10 minutes, which is very handy.
In a variation of a project I did for fieldwork, I collected a bunch of medicine bottles with various opening mechanisms for people to practice functional hand skills, and contained it nicely so that it could easily be taken to any room in the hospital. Another easy thing that I did during a slow day at work was to compile fine motor kits. We already had a handout and several existing supplies, but it just took time to do. Another activity that requires only time was cleaning out our supply closet. Just figuring out what we owned saved us money- we had 10 top quality walker bags just collecting dust!
Another easy project completed out of already existing materials was to create a pill sorting activity. We had dozens of colored beads in a small container and pill boxes (and also medicine bottles from my previous project). So I made a small chart with days of the week and the numbers and colors of beads for that day. It's a combined fine motor and cognitive activity. For a higher level client, I used a medication chart (made up by a pharm student) and correlated each real medication with a color of bead.
Something that I didn't put on my annual review sheet, but try to do, is just to fill in and be useful where needed. Paperwork, fixing things, doing the small tasks can have a positive impact on your coworkers. Sewing a button back on the Peabody kit during lunch got me a great review from the OT I job shadowed. The little things can make a big difference :)
9.15.2008
A Thankfully Slow Day
Our skilled unit has had a mass exodus over the weekend, leaving us with only 8 people, only 5 receiving therapy. The acute care side is busier, however, and I have learned how this pattern will end. We will go from being underbooked to dreadfully overbooked in 1-2 days, most likely at a time when I am the only OT and will get stuck doing all the evals. But, until then, I appreciate what we have now. It was a fortunate occurrence since the COTA was only working a half day, I had peds in the afternoon, and we got several evals in the course of the morning.
Mr. H went home with his daughter. He improved quickly in a short time. Hopefully, she will get him some good outpatient and driver rehab. She was a home care nurse, very good about asking questions and continuing therapy work, so I think it will go well.
My new pt. is Mrs A, who fell and sustained an L4 and pubic ramus fractures. I have a terrible time with elderly ladies with compression fractures. 1) they are in a lot of pain; 2) most of the ones I see were living independently but... 3) they have to wear a brace when out of bed and 4) have to be able to don it independently in order to live independently. For those of you who have not had a compression fracture, the braces all wrap around the torso and fasten on the sides or the front. They may need to be tightened considerably, and this is very difficult to do on yourself, especially if you have arthritis or other ailments. The usual prescribed brace is a hard or soft TLSO (turtleshell) or a corset brace. I have tried and tried teach this to different pts without success- they just can't gt the braces tight enough to be supportive. Anyone have a foolproof idea for this?
Had my annual review today- yay, they're going to keep me! ;) My supervisor loved that I had made up a list of handouts I had made, treatment tools I had made, continuing education, networking and service activities. It was a really informal bulletted list, but it made her job easier. It's an easy thing to do, and good to do as a student for your Level II placements. When I was a student, I made a sheet of pts I had evaluated, written evals or notes for, or just filled in for treatments. It also made it easier to fill out my university's form evaluation of the fieldwork site, which required you to answer caseload questions and specify diagnoses treated.
Mr. H went home with his daughter. He improved quickly in a short time. Hopefully, she will get him some good outpatient and driver rehab. She was a home care nurse, very good about asking questions and continuing therapy work, so I think it will go well.
My new pt. is Mrs A, who fell and sustained an L4 and pubic ramus fractures. I have a terrible time with elderly ladies with compression fractures. 1) they are in a lot of pain; 2) most of the ones I see were living independently but... 3) they have to wear a brace when out of bed and 4) have to be able to don it independently in order to live independently. For those of you who have not had a compression fracture, the braces all wrap around the torso and fasten on the sides or the front. They may need to be tightened considerably, and this is very difficult to do on yourself, especially if you have arthritis or other ailments. The usual prescribed brace is a hard or soft TLSO (turtleshell) or a corset brace. I have tried and tried teach this to different pts without success- they just can't gt the braces tight enough to be supportive. Anyone have a foolproof idea for this?Had my annual review today- yay, they're going to keep me! ;) My supervisor loved that I had made up a list of handouts I had made, treatment tools I had made, continuing education, networking and service activities. It was a really informal bulletted list, but it made her job easier. It's an easy thing to do, and good to do as a student for your Level II placements. When I was a student, I made a sheet of pts I had evaluated, written evals or notes for, or just filled in for treatments. It also made it easier to fill out my university's form evaluation of the fieldwork site, which required you to answer caseload questions and specify diagnoses treated.
9.13.2008
OT WebGems- Autism Edition
Welcome back! It's time for more OT-related WebGems! I'm still hoping that this phrase is not copyrighted! As I have previously acknowledged, I and everyone else have a lot that we need to learn about autism. Hats off to the millions of parents who know far more about what works and what doesn't from their practical experience than I do from books and work. Here's a few newsclips about some up and coming autism research.
Genetic social skills- These researchers looked at the social skills of parents who had children with autism. 15% of the parents were classified as "socially aloof," and the researchers wonder if this is a genetic link to some of the social skills deficits in children w/ autism. I just hope it doesn't bring back the "refrigerator mom" theory.
Early Intervention- Researchers from the University of Michigan have started a 5 year study looking at how early intervention can effect social skills and language development of toddlers with autism. Study participants get 25 hours/week of therapy for 2 years, including ABA treatment and parent training.
Fever as a productive time- Researchers studied children with autism before and after having a fever, finding improved concentration, language skills and eye contact immediately following a fever. They offer this as "an exciting lead" in autism treatments, and offer anecdotal evidence for this reaction as well.
Robot Playmates- A group of engineers studied how children with autism interacted with a robotic playmate that was equipped to blow bubbles. This was a very small study, but an interesting lead. A little odd, but interesting nonetheless.
Susan Senator- This woman has raised 3 children, including a child with autism. She is the author of "Making Peace with Autism," which I would like to read. Here are two of her essays- one on kids using the word "retarded" in an inappropriate way, and one on the difficulty of choosing a residential school. I know that if I would have used "retarded" as a putdown, my mother would have taken in out on me as if I had used the N-word, F-word, etc.
Genetic social skills- These researchers looked at the social skills of parents who had children with autism. 15% of the parents were classified as "socially aloof," and the researchers wonder if this is a genetic link to some of the social skills deficits in children w/ autism. I just hope it doesn't bring back the "refrigerator mom" theory.
Early Intervention- Researchers from the University of Michigan have started a 5 year study looking at how early intervention can effect social skills and language development of toddlers with autism. Study participants get 25 hours/week of therapy for 2 years, including ABA treatment and parent training.
Fever as a productive time- Researchers studied children with autism before and after having a fever, finding improved concentration, language skills and eye contact immediately following a fever. They offer this as "an exciting lead" in autism treatments, and offer anecdotal evidence for this reaction as well.
Robot Playmates- A group of engineers studied how children with autism interacted with a robotic playmate that was equipped to blow bubbles. This was a very small study, but an interesting lead. A little odd, but interesting nonetheless.
Susan Senator- This woman has raised 3 children, including a child with autism. She is the author of "Making Peace with Autism," which I would like to read. Here are two of her essays- one on kids using the word "retarded" in an inappropriate way, and one on the difficulty of choosing a residential school. I know that if I would have used "retarded" as a putdown, my mother would have taken in out on me as if I had used the N-word, F-word, etc.
9.10.2008
Play Ball!
Had a really fun treatment today. Props to Mr A for withstanding over 2 hours of therapy today and to my pseudo-boss for being willing to listen to my ideas. Mr H is in his upper 80's and had a basilar artery stroke. When I first saw him in the hospital last week, he had poor sitting balance, very poor standing balance, and couldn't hold onto a walker w/ his R hand. Since then, he has made some great progress. (sidenote- spontaneous recovery is a frustrating concept to me. I wish that you could predict why some people get great recovery from cerebral events quickly, and others never do. me=control freak)
I had spent 45 minutes before lunch working with him sitting EOB while doing resistive clothespins and reaching in all planes, also did the extreme fine motor kit. No sitting balance issues. Sitting balance is the precursor to standing balance, so yes, this is relevant to his continued independence. Teaming up w/ my experienced PT friend and a rehab aide, we later found Mr A game to try our sitting balance game. We got to sit him on a ball, where he did great with dynamic sitting balance, even after incorporating throwing and catching another ball. Great BUE coordination. The only thing he didn't do well was the cognitive portion of this that we eventually worked up to- naming a different major city with every throw. We did try some dynamic standing at the end of this exercise, but that is still in the future.
This is the 2nd time in a year of employment that I have seen/heard of the ball being used. The first time, I was sitting on it to eat lunch. It makes me miss the rehab center, makes me find a commonality with a non-particularly-liked employee of said center who told me during my fieldwork that she could never NOT work on the stroke team, as the other diagnoses were boring. It certainly is interesting and sparks my curiosity over my future again... I have strong interests in CVA and SCI but they are generally separated and very specialized.
I had spent 45 minutes before lunch working with him sitting EOB while doing resistive clothespins and reaching in all planes, also did the extreme fine motor kit. No sitting balance issues. Sitting balance is the precursor to standing balance, so yes, this is relevant to his continued independence. Teaming up w/ my experienced PT friend and a rehab aide, we later found Mr A game to try our sitting balance game. We got to sit him on a ball, where he did great with dynamic sitting balance, even after incorporating throwing and catching another ball. Great BUE coordination. The only thing he didn't do well was the cognitive portion of this that we eventually worked up to- naming a different major city with every throw. We did try some dynamic standing at the end of this exercise, but that is still in the future.
This is the 2nd time in a year of employment that I have seen/heard of the ball being used. The first time, I was sitting on it to eat lunch. It makes me miss the rehab center, makes me find a commonality with a non-particularly-liked employee of said center who told me during my fieldwork that she could never NOT work on the stroke team, as the other diagnoses were boring. It certainly is interesting and sparks my curiosity over my future again... I have strong interests in CVA and SCI but they are generally separated and very specialized.
Mornings
I HATE mornings. I would much rather stay up til 3 or 4 than ever get up before 9. I really hate it. And in the past few days, it's started to turn more into fall, which means that it's dark and cold when I wake up. As if I needed extra motivation to stay in bed. I had a terrible time making it to my one fieldwork on time, since it was darkest winter, and I ended up walking through the snow half the time. Being roused unwillingly out of bed and then having to tramp 1 mile in snow boots is not how I like to start the day. I just hate mornings... if only I liked outpatient better, then I could sleep in later.
9.06.2008
OT WebGems- Edition #1
I routinely bookmark articles or websites with the intent to blog on them... sometimes they either get outdated or I just don't have enough to say on the article to be a whole legit post. So, in a shameless act of thievery from ESPN, I bring you the first installment of OT-Related WebGems! Today's theme: Back to school. Several selections for parents, and 1 for therapy students.
Motivating Students- Jay Matthews writes a summary of tips for teachers on motivating students, with better strategies than just grades. I think there's some good tips here that parents and teachers should discuss together.
Bike Safety- Somewhat of a tenuous link to school, but I'd like to believe that in some small town America, there are still kids that ride a bike to school. This set of articles was a nice comprehensive look into safety that includes video on how to properly adjust a helmet. Teach your kids safety and prevent injury!
Family Manager- Kathy Peel offers free tips on home organization. This is a set on getting out the door on time in the morning. She has also authored The Busy Mom's Guide if you are interested in further information.
Day Care Research- A short review of a study that should allay some fears of dropping your child at day care. Doesn't resolve anything, but if it helps your debate, I spent my first 5 years in a family-run daycare with no lasting negative outcomes.
Choosing a Partner- This was written about Presidential candidates choosing VPs, but it can be easily generalized to other working relationships. Attention therapy students: know thine research partner, before committed to years of work. I picked a friend that I knew was conscientious about deadlines and would get the information we needed from our adviser. I didn't pick my best friend, because we had studied together before and I knew that I would just spend research time chatting about irrelevant things instead of working. Research is a big part of most schools' graduation requirements, so choose wisely.
Motivating Students- Jay Matthews writes a summary of tips for teachers on motivating students, with better strategies than just grades. I think there's some good tips here that parents and teachers should discuss together.
Bike Safety- Somewhat of a tenuous link to school, but I'd like to believe that in some small town America, there are still kids that ride a bike to school. This set of articles was a nice comprehensive look into safety that includes video on how to properly adjust a helmet. Teach your kids safety and prevent injury!
Family Manager- Kathy Peel offers free tips on home organization. This is a set on getting out the door on time in the morning. She has also authored The Busy Mom's Guide if you are interested in further information.
Day Care Research- A short review of a study that should allay some fears of dropping your child at day care. Doesn't resolve anything, but if it helps your debate, I spent my first 5 years in a family-run daycare with no lasting negative outcomes.
Choosing a Partner- This was written about Presidential candidates choosing VPs, but it can be easily generalized to other working relationships. Attention therapy students: know thine research partner, before committed to years of work. I picked a friend that I knew was conscientious about deadlines and would get the information we needed from our adviser. I didn't pick my best friend, because we had studied together before and I knew that I would just spend research time chatting about irrelevant things instead of working. Research is a big part of most schools' graduation requirements, so choose wisely.
9.05.2008
Past Medical History- what are you looking for?
While taking the medical history doesn't often fall to the therapist, it should be part of any evaluation and chart review. But sorting through a thick chart can get complex. Here are some important conditions to look for in your PMH. (not necessarily in order of importance)
- Cardiac conditions- this includes prior MI, HTN, A-Fib, CHF, TIA, CVA. Important for pacing of activities and planning exercise programs. From my experience, many people who have had a prior cardiac event continue to remain at-risk instead of taking the steps toward lifestyle change necessary to decrease their risk factors.
- COPD and other respiratory conditions- Is your pt. on oxygen at home, or should you be working on weaning to room air? Is this person prone to quick desaturation? Will you need a pulse-oximeter or portable O2 tank for this person? You may need to do endurance building activities, and be especially wary of hot showers!
- Cancer- many sources advocate against aggressive strengthening programs for individuals with active cancer, and especially metastases. Also, a woman with a mastectomy should never be lifted by that arm or have a blood pressure taken in that arm.
- Orthopedic surgery- obviously, a recent joint replacement will have a weight bearing status and appropriate precautions to note. But hip precautions are in effect for 3 months, and some of the hospital clientele will certainly be readmitted during that time period. If a person didn't receive adequate therapy following a joint replacement, they may still lack ROM in that joint.
- Falls- many hospital patients are labeled as at-risk for falls. But it's important to know how often and where your patient has been falling. Does this person need extra practice on tub transfers? A home evaluation and education on modifications? An assistive device? Increased supervision and physical assistance?
- DVT/PE- If your patient has a history of clots, you should be extra vigilant of preventative measures implemented by the MD and nursing staff. This includes the sequential compression devices for legs and the TED hose. Our facility has guidelines for usage of these and documentation to accompany it. You should also be aware if your patient develops a pain (particularly in the leg), and talk to the nursing staff about the possibility of this being a DVT. Pt. may need to rest that day, get a doppler study just to clear everything up. Better to be safe than sorry.
- Diabetes and other diet restrictions- important to note especially for cooking activities or just to have a quick answer for "Can I have a Coke?"
- Current UTI- this may not mean much in the history column, as most every person in the world has had at least one in the lifetime. However, a current UTI can cause a decrease in your pt's cognition, endurance, and balance. If there is a history of frequent UTI, that can be connected to incontinence, which is a good thing to take note of prior to getting someone totally dressed for ADLs.
9.03.2008
Threshold of Thursday
Doing my scrubs washing tonight so that I can go into work tomorrow (my day off) and Friday, and Saturday. bummer. Actually got some new, cool, non-kid tops that I can wear and be fashionable in at the hospital (not that the elderly don't get a kick out of my Land Before Time, Rugrats, and Spongebob shirts). Anyway, I usually don't go in on Thursdays as long as everyone is healthy and happy. But this week is our first week of evening pediatric schedule. Since it's been a short week, I can't say that I've really learned a whole lot yet (except for the fact that a 530 pt makes it very hard to get to your 600 meeting). I've been handling the peds on my own now since last December, and tomorrow marks the handoff of twice-weekly kids to the COTA. I am not worried about this, for the following simple reasons 1) her slots will be used primarily to see the "twice-weeklies." By definition, I will also be seeing these kids at other times during the week, and will be reviewing their notes weekly by necessity. I have been seeing both these kids for many months, they have great involved parents, and they are both OT/PT cotreats. 2) I trust the COTA. We're in the same office at least 3 days a week with ample time to discuss treatments or issues.
I'm confident that the COTA has the basic skills to easily succeed in this. My only worry is whether the girl who has autism will adapt to seeing different faces Tues/Thurs. She, however, is not as confident. As she pointed out today, it is a totally different world going from the inpatient environment to pediatrics. There is really very little transfer between the two worlds. Yes... we're still OT, still client centered, still focused on ADLs. Still, VERY different. One big difference is that even when our adults have comorbidities, it doesn't change your overall treatment plan too much. A person with a knee replacement often has the same general treatment course as a person with a knee replacement and a typical comorbidity. Yet the comorbidities that the kids have generally have a profound impact on your treatment activities. Think co-occurring SPD with autism; TBI and CP; dyspraxia and dyslexia. Both environments can be overwhelming until you're adjusted. We've chatted about the different kids, discussed goals and treatment ideas, but I think she's still a bit nervous. So, we're teaming up tomorrow as a reintroduction to peds, and then next week (due to massive scheduling problems) she'll do all the cotreats solo.
I expect the whole fall transition and dealing with vacations will be hectic, but not overlly problematic. My main problem is getting (certain) parents to be responsible and make appointments. The pediatric PT is bemoaning her full schedule... I wish I had that problem. Can't really get all into peds if I don't have the caseload to do it. We do finally have a speech therapist, but I don't know if she is interested/able to take on pediatric outpatients. And until we have someone to do that, we have been discouraged from actively marketing our pediatric services. So we're basically left to whomever wanders in. I did make a good connection with a family therapist who specializes in Asperger's Syndrome, and she said that she would be speaking with the doctor about OT referral for sensory issues. For now, we wait.
I'm confident that the COTA has the basic skills to easily succeed in this. My only worry is whether the girl who has autism will adapt to seeing different faces Tues/Thurs. She, however, is not as confident. As she pointed out today, it is a totally different world going from the inpatient environment to pediatrics. There is really very little transfer between the two worlds. Yes... we're still OT, still client centered, still focused on ADLs. Still, VERY different. One big difference is that even when our adults have comorbidities, it doesn't change your overall treatment plan too much. A person with a knee replacement often has the same general treatment course as a person with a knee replacement and a typical comorbidity. Yet the comorbidities that the kids have generally have a profound impact on your treatment activities. Think co-occurring SPD with autism; TBI and CP; dyspraxia and dyslexia. Both environments can be overwhelming until you're adjusted. We've chatted about the different kids, discussed goals and treatment ideas, but I think she's still a bit nervous. So, we're teaming up tomorrow as a reintroduction to peds, and then next week (due to massive scheduling problems) she'll do all the cotreats solo.
I expect the whole fall transition and dealing with vacations will be hectic, but not overlly problematic. My main problem is getting (certain) parents to be responsible and make appointments. The pediatric PT is bemoaning her full schedule... I wish I had that problem. Can't really get all into peds if I don't have the caseload to do it. We do finally have a speech therapist, but I don't know if she is interested/able to take on pediatric outpatients. And until we have someone to do that, we have been discouraged from actively marketing our pediatric services. So we're basically left to whomever wanders in. I did make a good connection with a family therapist who specializes in Asperger's Syndrome, and she said that she would be speaking with the doctor about OT referral for sensory issues. For now, we wait.
8.30.2008
OT blog resources
Got an email from a Canadian OT student who has started collecting OT blogs and compiling them here for ease of reading and access. Seems a little cleaner than the AOTA blogroll effort, though to be fair, I haven't been visiting that regularly. I keep finding new ones that are OT or related and adding them to my google reader application. I wouldn't be able to read all the things that I do without it, so if you make a cool change to your layout, put it in a blog post so that I know to check it out :-P
I have a whole folder full of links to share... articles picked up on Advance or Therapy Times or the local newspaper. I will get to that soon (I promise!) and also finally watch my awesome sensory integration video and post my reflections from it.
Closing thought: Is Lou Holtz secretly supporting OT? We definitely figure in at least 3 of these-
"Everyone needs four things:
something to do
someone to love
something to hope for
something to believe in"
I have a whole folder full of links to share... articles picked up on Advance or Therapy Times or the local newspaper. I will get to that soon (I promise!) and also finally watch my awesome sensory integration video and post my reflections from it.
Closing thought: Is Lou Holtz secretly supporting OT? We definitely figure in at least 3 of these-
"Everyone needs four things:
something to do
someone to love
something to hope for
something to believe in"
8.27.2008
Happy holiday, unless you work in a SNF
Every setting has its own complex rules and regulations, but it seems that the Skilled Nursing Facilities (SNF) get more than their fair share. Payment for therapy services rendered is dependent upon meeting a set number of minutes in a pt's week (starting on their admission). To be even more complicated, I have heard that the first week's payment actually is a prospective payment for the second week... I cannot go into that as it is far too dizzying. At any rate, a pt. must be seen for at least 15 minutes to count as a 'day' of therapy. In addition to meeting a certain number of minutes of therapy per 7 days, there are also requirements of how many 'days' of therapy a person needs.
blah blah blah paperwork.
So here's where the holidays wreak havoc. If pt. X is admitted on Wednesday the 27th (and is evaluated and treated that day, not a given), they will need 4 more 'days' of treatment for most levels. So between Saturday, Sunday, and Labor Day, this pt. will have to be seen by at least one therapy, and will likely have to make up extra time during the regular work week. So for any pt. that is in their first 14 days, there is a crush to get extra time. Also, this is why most SNFs require therapists to work weekends and many holidays. Kind of a bummer.
Another bummer from the 'days' side of things has been happening a lot at my place recently. A person cannot be discharged from the hospital and admitted to the SNF floor w/o a doctor's order. So even if all the plans have been made through case management and the SNF admission planner, if no one writes an order, the pt. sits and languishes in hospital bed limbo. Also, the therapist's wobble and wait for word on whether the pt. will come that day, night, or the next. You can wait around, have a pt. show up at 4:55 and wind up working over. Or you can wait around for naught since they won't show til 8:30. Regardless of whether they are evaluated or not, treated or not, that still starts their week and leaves only 6 more days to work. And if you just happen to have a person who is too sick to participate 1 or 2 days... it just makes it all harder.
I gave my best today to try to be extra motivating to my lil' ladies down my hallway... especially since I shant be helping the rest of the team again until Tuesday (which also starts new peds sched). I am taking an extended weekend to go home and decrease my loneliness by visiting w/ friends and family. I have been doing fair with my goals... 2 social activities this week and 1 trip to the rec center, a finished jigsaw puzzle, another load of laundry, and a nice long phone call with a friend. But the townhouse gets quiet. So posts might be less frequent than planned this weekend, but at least I'll be having fun. :)
PS- funny note: Laughed a lot the other day as an MD stalled out his manual-transmission sports car while trying to key in the password to the MD lot on a teeny tiny slope. I don't drive a stick very well, but I also didn't drop BIG BUCKS on a fancy schmancy sports car. :-P
blah blah blah paperwork.
So here's where the holidays wreak havoc. If pt. X is admitted on Wednesday the 27th (and is evaluated and treated that day, not a given), they will need 4 more 'days' of treatment for most levels. So between Saturday, Sunday, and Labor Day, this pt. will have to be seen by at least one therapy, and will likely have to make up extra time during the regular work week. So for any pt. that is in their first 14 days, there is a crush to get extra time. Also, this is why most SNFs require therapists to work weekends and many holidays. Kind of a bummer.
Another bummer from the 'days' side of things has been happening a lot at my place recently. A person cannot be discharged from the hospital and admitted to the SNF floor w/o a doctor's order. So even if all the plans have been made through case management and the SNF admission planner, if no one writes an order, the pt. sits and languishes in hospital bed limbo. Also, the therapist's wobble and wait for word on whether the pt. will come that day, night, or the next. You can wait around, have a pt. show up at 4:55 and wind up working over. Or you can wait around for naught since they won't show til 8:30. Regardless of whether they are evaluated or not, treated or not, that still starts their week and leaves only 6 more days to work. And if you just happen to have a person who is too sick to participate 1 or 2 days... it just makes it all harder.
I gave my best today to try to be extra motivating to my lil' ladies down my hallway... especially since I shant be helping the rest of the team again until Tuesday (which also starts new peds sched). I am taking an extended weekend to go home and decrease my loneliness by visiting w/ friends and family. I have been doing fair with my goals... 2 social activities this week and 1 trip to the rec center, a finished jigsaw puzzle, another load of laundry, and a nice long phone call with a friend. But the townhouse gets quiet. So posts might be less frequent than planned this weekend, but at least I'll be having fun. :)
PS- funny note: Laughed a lot the other day as an MD stalled out his manual-transmission sports car while trying to key in the password to the MD lot on a teeny tiny slope. I don't drive a stick very well, but I also didn't drop BIG BUCKS on a fancy schmancy sports car. :-P
8.23.2008
Pondering the future
In the same way that working with elderly clients can make you a little morbid, it can also have you question your future. Specifically- what kind of old lady am I going to be? Cranky in the morning, but that's a given. Are my popping knees going to deteriorate badly enough for me to need replacements? Will I be a regarded as a whiny wuss during my rehab by a bunch of young punks? Will I get osteoporosis and become the new record holder for most fractures? Will my rehab from whatever afflicts me go slow, and require me to toil away at a long term SNF for months on end when all I want to do is go home? Will my family offer me physical assistance or leave me to languish alone? Will my body decay before my mind, or vice versa?
I don't worry about this stuff too often (although the knee replacement issue does eat at the back of my mind) but it is interesting to contemplate. I try to adapt my approach to different age groups. I can be a real dictator for the under-60 joint replacements, but do try to show my kinder, gentler side to the 85+ crowd. Not that I'm not nice to everyone, but I'm more likely to let an older pt. say, "I'm too tired" and have it be enough to call off a treatment. I try to impress more on the older clients that they can refuse treatment, that they can take rest breaks, because more often than not they feel obligated to participate as much as physically possible, and really do need the rest. For those of you who haven't worked in a SNF or other environment with the elderly, you've probably never contemplated the physical exercise and strain of sitting up in a chair for the morning. I know with the 85+ crowd that the physically/mentally straining activities need to be in the morning, before sitting up too long tires them out. If I do anything in the afternoon, I usually preface it with "I only need a few minutes" or "we just need to do 1 thing today" or "we will do this and go back to bed." Please don't send me emails about how I'm simplifying this too much or patronizing my clients... this is just a description of the typical response for the age group, not your overly active grandma.
I also ponder my near future a good deal. I have a habit of throwing myself into whatever I'm currently doing, which sometimes makes it hard to plan farther ahead. I've been investing a lot of time into pediatric and sensory stuff, even though that wasn't an area that I thought I'd ever go into before I started this job. I don't want to leave this knowledge behind and start from scratch on my next job, but I don't know what exactly I want to do on my next job. Or the rest of my life. This is part of why I went into OT as a student- because there are lots of options and you can completely change your daily job life without needing more education. But, I don't want to keep starting from scratch bouncing into different settings. I've often thought that my next job should be back into that demanding world of inpatient rehab, but that can really be stressful. I don't have the experience at this point to go to a top-shelf place, and also don't know if I could take the pressure. I feel a responsibility to myself and a lot of different people to do great things, go great places, live up to potential. Probably more of my 'great things' that I actually end up doing will be pretty mundane and in small places, and deep down I know that's ok too and that no one will be disappointed. Still... need some good career goals.
I don't worry about this stuff too often (although the knee replacement issue does eat at the back of my mind) but it is interesting to contemplate. I try to adapt my approach to different age groups. I can be a real dictator for the under-60 joint replacements, but do try to show my kinder, gentler side to the 85+ crowd. Not that I'm not nice to everyone, but I'm more likely to let an older pt. say, "I'm too tired" and have it be enough to call off a treatment. I try to impress more on the older clients that they can refuse treatment, that they can take rest breaks, because more often than not they feel obligated to participate as much as physically possible, and really do need the rest. For those of you who haven't worked in a SNF or other environment with the elderly, you've probably never contemplated the physical exercise and strain of sitting up in a chair for the morning. I know with the 85+ crowd that the physically/mentally straining activities need to be in the morning, before sitting up too long tires them out. If I do anything in the afternoon, I usually preface it with "I only need a few minutes" or "we just need to do 1 thing today" or "we will do this and go back to bed." Please don't send me emails about how I'm simplifying this too much or patronizing my clients... this is just a description of the typical response for the age group, not your overly active grandma.
I also ponder my near future a good deal. I have a habit of throwing myself into whatever I'm currently doing, which sometimes makes it hard to plan farther ahead. I've been investing a lot of time into pediatric and sensory stuff, even though that wasn't an area that I thought I'd ever go into before I started this job. I don't want to leave this knowledge behind and start from scratch on my next job, but I don't know what exactly I want to do on my next job. Or the rest of my life. This is part of why I went into OT as a student- because there are lots of options and you can completely change your daily job life without needing more education. But, I don't want to keep starting from scratch bouncing into different settings. I've often thought that my next job should be back into that demanding world of inpatient rehab, but that can really be stressful. I don't have the experience at this point to go to a top-shelf place, and also don't know if I could take the pressure. I feel a responsibility to myself and a lot of different people to do great things, go great places, live up to potential. Probably more of my 'great things' that I actually end up doing will be pretty mundane and in small places, and deep down I know that's ok too and that no one will be disappointed. Still... need some good career goals.
8.22.2008
Things that make you go ugh!
Life is never without irony. So, the day after I write up a nice thing on paperwork and goal writing, I discover that I had totally neglected to write goals for a child that I had seen for the eval and an additional session to do the Peabody. I rarely delay documentation and really don't know what I was thinking this time, but it had to be done today since he is on the COTA's schedule next. Must have some kind of treatment plan to begin the collaboration.
In other, crappier, news, we have had more ICU patients than usual. One of them had been doing pretty well and went into a coma. He died yesterday. One had gotten better, moved to the regular unit and even down to the transitional care unit. A few hours after his transfer to the SNF floor, he developed some additional cardiac problems and wound up back in ICU. One has been undergoing very limited treatment, mostly PROM, w/o much progress for 2 weeks or more. One was an outpatient who developed CHF and respiratory failure- her future is bleak.
One of the reasons I went into OT was because I didn't want to be dealing with life and death emergencies. I like my patients to get better, go home, stay out of the hospital. Unfortunately, in the hospital and/or SNF setting, that is not always the case. It's a little morbid, but fairly common, for hospital staff (therapy included) to be regular checkers of the local obituaries. And no matter how uncomfortable it makes us as therapists, there are moments that we do endanger our patients- not knowingly, but still. Several months ago, when I had the patient fall, we didn't know it at the time, but she had developed A-fib and was going into renal failure. She left the SNF floor for ICU no more than a day after we had the fall.
Sometimes the only thing standing between you and disaster is an experienced coworker. There's been a number of times when the rehab aide has taken a look at a patient and advised to lay off, or noticed diaphoresis early... she's probably stopped a lot of falls and other problems just from experience and observation skills. Mad props to her- and attention students- don't rule anybody out as a potential teacher. There are a lot times when your masters/doctorate degree doesn't mean a thing next to someone's experienced observations or practical skills they've developed over time. Make friends with these people, they will save you from being an idiot time an again.
One happy ICU story to mix in with all this sad stuff. Mrs. P was a middle age woman admitted w/ anoxic BI. When we first eval'd her, she was quite flat and making slow progress. Then she got bumped into ICU and was unresponsive for several days. Then... we got orders to resume therapy as she moved out to the regular floor. She was showing good memory, emotion, and moving so much better. It was as if she came out of the coma doing much better than when she went in. She's home now, and hopefully continuing to improve. If not, I guess I'll see it in the paper...
In other, crappier, news, we have had more ICU patients than usual. One of them had been doing pretty well and went into a coma. He died yesterday. One had gotten better, moved to the regular unit and even down to the transitional care unit. A few hours after his transfer to the SNF floor, he developed some additional cardiac problems and wound up back in ICU. One has been undergoing very limited treatment, mostly PROM, w/o much progress for 2 weeks or more. One was an outpatient who developed CHF and respiratory failure- her future is bleak.
One of the reasons I went into OT was because I didn't want to be dealing with life and death emergencies. I like my patients to get better, go home, stay out of the hospital. Unfortunately, in the hospital and/or SNF setting, that is not always the case. It's a little morbid, but fairly common, for hospital staff (therapy included) to be regular checkers of the local obituaries. And no matter how uncomfortable it makes us as therapists, there are moments that we do endanger our patients- not knowingly, but still. Several months ago, when I had the patient fall, we didn't know it at the time, but she had developed A-fib and was going into renal failure. She left the SNF floor for ICU no more than a day after we had the fall.
Sometimes the only thing standing between you and disaster is an experienced coworker. There's been a number of times when the rehab aide has taken a look at a patient and advised to lay off, or noticed diaphoresis early... she's probably stopped a lot of falls and other problems just from experience and observation skills. Mad props to her- and attention students- don't rule anybody out as a potential teacher. There are a lot times when your masters/doctorate degree doesn't mean a thing next to someone's experienced observations or practical skills they've developed over time. Make friends with these people, they will save you from being an idiot time an again.
One happy ICU story to mix in with all this sad stuff. Mrs. P was a middle age woman admitted w/ anoxic BI. When we first eval'd her, she was quite flat and making slow progress. Then she got bumped into ICU and was unresponsive for several days. Then... we got orders to resume therapy as she moved out to the regular floor. She was showing good memory, emotion, and moving so much better. It was as if she came out of the coma doing much better than when she went in. She's home now, and hopefully continuing to improve. If not, I guess I'll see it in the paper...
8.20.2008
Writing Goals
This blog was started with interests in helping students and also in describing my current OT life, so this entry should be an interesting mix. My husband left for an extended trip to Europe today, and I was trying to make a list of things to do while he's away and realized it would be a good time to offer some instruction on goal writing. Some of this information is taken from my notes on the required documentation book from my first year (long since sold, so I can't check on anything else in it).
There are a few basic types of goals, but most of what I write are restorative, modification, or new skill goals. If you are writing a goal with the intent to maintain something in a client's life, or prevent something from happening, you're on shaky ground (ie- may not be reimbursed by insurance or covered in scope of practice). If you've got a grant for a special program focusing on preventive care or health promotion, more power to you, but most people want evidence that the goal has been achieved within a reasonable time frame and primarily due to your OT intervention before they pay you.
When starting at a new setting or when out on fieldwork, focusing on writing good goals can be a little overwhelming. A note to the fieldwork students- every supervisor has different expectations for documentation (also, they have every right to be demanding, as their name goes on it too). A good supervisor will tell you though that as you start being 'a real OT/A' that you will develop your own style of documentation that still retains the basic needs (hopefully!). This can be easier to do if you have a framework to go off of. I used the SMART model in school, here are a few more:
Another problem that fieldwork students often have is knowing what issues to write a goal about. As a rule, if you want to work as an OT practitioner, you need some occupation-based goals. It simply cannot be all about ROM, strengthening, or mobility in your wording, and should not be in your approach. With my hospital patients, I try to have 2 ADL goals, 1 mobility goal, 1 exercise goal, 1 home safety goal. (That's the baseline, I add and subtract based on pt ability) In the few hand evals that I did, I would have a ROM goal, strength goal, HEP goal, and 1-2 specific occupation goals. (the CHT at my site often uses "pt. will identify x# new daily tasks she is capable of performing w/ RUE") With the kids, it is all very different due to their needs, but there is often a sensory goal, 1-2 school readiness goals, parent program goal.
Examples- these are all based off of my life, and written while watching softball, so they aren't exactly what you would want in your setting, but it should give a reasonable idea.
One thing about goals that I need some HELP in!! Does anyone know the legality of whether you can write a goal for a child that directly relates to their MRDD Waiver Program family goal? Since the family is financially reimbursed for meeting the goal, it seems like shaky ground. Anyone have information on this?
There are a few basic types of goals, but most of what I write are restorative, modification, or new skill goals. If you are writing a goal with the intent to maintain something in a client's life, or prevent something from happening, you're on shaky ground (ie- may not be reimbursed by insurance or covered in scope of practice). If you've got a grant for a special program focusing on preventive care or health promotion, more power to you, but most people want evidence that the goal has been achieved within a reasonable time frame and primarily due to your OT intervention before they pay you.
When starting at a new setting or when out on fieldwork, focusing on writing good goals can be a little overwhelming. A note to the fieldwork students- every supervisor has different expectations for documentation (also, they have every right to be demanding, as their name goes on it too). A good supervisor will tell you though that as you start being 'a real OT/A' that you will develop your own style of documentation that still retains the basic needs (hopefully!). This can be easier to do if you have a framework to go off of. I used the SMART model in school, here are a few more:
- SMART: Significant, Measurable, Achievable, Relates to person, Time based
- ABCD: Audience, Behavior, Condition, Degree
- FEAST: Function, Expectation, Action, Specific conditions, Timeline
- RHUMBA: Relevant, How long, Understandable, Measurable, Behavioral, Achievable
Another problem that fieldwork students often have is knowing what issues to write a goal about. As a rule, if you want to work as an OT practitioner, you need some occupation-based goals. It simply cannot be all about ROM, strengthening, or mobility in your wording, and should not be in your approach. With my hospital patients, I try to have 2 ADL goals, 1 mobility goal, 1 exercise goal, 1 home safety goal. (That's the baseline, I add and subtract based on pt ability) In the few hand evals that I did, I would have a ROM goal, strength goal, HEP goal, and 1-2 specific occupation goals. (the CHT at my site often uses "pt. will identify x# new daily tasks she is capable of performing w/ RUE") With the kids, it is all very different due to their needs, but there is often a sensory goal, 1-2 school readiness goals, parent program goal.
Examples- these are all based off of my life, and written while watching softball, so they aren't exactly what you would want in your setting, but it should give a reasonable idea.
- To demonstrate increased leisure participation, Cheryl will attend activities with friends 1x/week for 3 weeks.
- In 3 weeks, Cheryl will complete 10 crossword puzzles at modified independent level with use of google.
- Cheryl will complete 80%+ of her exercise program at the wellness center 3 days/week.
- Cheryl will play fewer than 50 computer games per week to decrease c/o wrist pain.
One thing about goals that I need some HELP in!! Does anyone know the legality of whether you can write a goal for a child that directly relates to their MRDD Waiver Program family goal? Since the family is financially reimbursed for meeting the goal, it seems like shaky ground. Anyone have information on this?
8.05.2008
Brief recap
Last week:
-Mondays are not Fundays... especially when only 2 people are left to manage inpatient and outpatient... 1 COTA, 1 OT... 2 outpatient schedules... plenty of hospital evaluations.
-Tuesday was also shorthanded and always unfun. We usually split patients not by the amount of time required to treat, but just by the number of patients, which can lead to some major discrepancies on these days.
-Wednesdays are also not fun due to routinely scheduled staffing shortages. Made it through and then got a visit from my parents! First time they have been out to my new place. The rest of the week (parts not devoted to work) was devoted to tourist-type fun and awesome restaurants.
This week:
Another shorthanded Monday with 5 evals and treatments of adults and 5 kids as well. Worked through lunch to make a social skills worksheet identifying "potential friends" for a kid w/ Aspergers. Will post that later...
Today I had some extra clerical work but was unwilling to stay and do it after an 11 hour Monday.
I've been a very involved Olympics fan for a long time... I'd 1994 is the first games that I remember, though I do remember the 92 Dream Team somewhat. Really hate that I have to go to bed before fun stuff happens (Men's gymnastics bronze!!) and need to get better w/ the DVR. I've highlighted all the fun events I want to see (approx 2200) and will not have a lot of computer time devoted to non-Olympic pursuits for awhile. :) Husband is leaving for overseas multi-week job placement soon, so I'll have a considerable amount of time to dedicate to different projects. Part of that will be uploading various files to share with the online community. Other OT-related projects include preparing for my annual review, calling and scheduling parents for the school year, and looking at the feasibility of doing a research study at my facility.
-Mondays are not Fundays... especially when only 2 people are left to manage inpatient and outpatient... 1 COTA, 1 OT... 2 outpatient schedules... plenty of hospital evaluations.
-Tuesday was also shorthanded and always unfun. We usually split patients not by the amount of time required to treat, but just by the number of patients, which can lead to some major discrepancies on these days.
-Wednesdays are also not fun due to routinely scheduled staffing shortages. Made it through and then got a visit from my parents! First time they have been out to my new place. The rest of the week (parts not devoted to work) was devoted to tourist-type fun and awesome restaurants.
This week:
Another shorthanded Monday with 5 evals and treatments of adults and 5 kids as well. Worked through lunch to make a social skills worksheet identifying "potential friends" for a kid w/ Aspergers. Will post that later...
Today I had some extra clerical work but was unwilling to stay and do it after an 11 hour Monday.
I've been a very involved Olympics fan for a long time... I'd 1994 is the first games that I remember, though I do remember the 92 Dream Team somewhat. Really hate that I have to go to bed before fun stuff happens (Men's gymnastics bronze!!) and need to get better w/ the DVR. I've highlighted all the fun events I want to see (approx 2200) and will not have a lot of computer time devoted to non-Olympic pursuits for awhile. :) Husband is leaving for overseas multi-week job placement soon, so I'll have a considerable amount of time to dedicate to different projects. Part of that will be uploading various files to share with the online community. Other OT-related projects include preparing for my annual review, calling and scheduling parents for the school year, and looking at the feasibility of doing a research study at my facility.
8.03.2008
Girl Scout Camp Postmortem
It is with considerable relief that I can finally sit down to type again of this week. Thanks to the beauty of scheduled posts, I could assure that my devoted readers (ha!) never missed me during my long and hard-fought days of work and scout camp. I was working with older girls, entering 5th-8th grades, on the theory that they would be more self-directed and require less help throughout everything. HA! There was a lot that I had forgotten about teenage girls, and between the age range and the sheer number of girls (15) we had some considerable struggles. But we persevered, earned our badges, and made it through the week. During the times when I wasn't leading a rowdy band of scouts, I also saw a bunch of kids and inpatients, as is par for the work course. Had to plan out the new school year schedule... it has 3 afternoon/evenings of kids, 2 eval spots, and 17 30-minute slots. Party. Also, I will be starting work a little later to avoid the dreaded 10-12 hour days that I was working. Hopefully I can work this so that I will also be able to be a scout leader (for most of my camp kids) on Tuesday nights, but it is too far to tell if that will work out.
Arm pain is back... I am now fairly certain that it is referred pain from my neck that is controlled by how I am sleeping at night. I am now trying a memory foam traveler's neck pillow to see if it will force me to sleep on my back w/o flexing my neck.
Had some interesting kids this week. Little Mr. Q is 4 y.o. but not in preschool, b/c mom can't afford it. I Peabody'd him, showing 10-month delays in object manipulation (ball use) and Visual Motor Integration. He jumps at a ball when you throw it to him, and thus, usually does not catch it. He also cuts with extreme forearm supination, which is the skill that tipped off the MD. I will be interested to see what the PT comes up with on Monday, and also need to tell Mom that Ollie's Bargain Outlet (one of my haunts) is carrying Pre-K instruction packs for $20.
Another child, Lil Mr. P, is an interesting story indeed. He was referred w/ a CP diagnosis, w/o his caregivers knowing it, and really does not match CP at all. I actually called the MD to make sure that he had written the dx correctly. What he does certainly have is dyspraxia, though the caregiver regarded me with extreme suspicion when I mentioned this and recommended Sensational Kids for further reading. (I like to refer to this book as I find it very informational and know that it is both at the local library and relatively inexpensive online.) Caregiver stated that he had an appt w/ a developmental pediatrician and that she would not make any more OT/PT appts until she had talked to him, b/c she doesn't think he needs therapy. Hopefully he will reiterate that Mr. P is not developing along the typical timeline and that he will need continued therapy, b/c he really can benefit.
That's about it for now... my parents are visiting later this week. I picked up the 2 headed crayons, but the RoseArt version, as they were only $2. I will also be making a list of projects to work on during the 3 weeks that my husband heads overseas for work. This really should include writing up some SPD stuff so that I can synthesize more of it in my brain, but also needs to have some tangible work for me to do. I'm thinking working out more, puzzles, artsy things. If I don't force myself to have a list, then I will just sit on the couch and do nothing.
Arm pain is back... I am now fairly certain that it is referred pain from my neck that is controlled by how I am sleeping at night. I am now trying a memory foam traveler's neck pillow to see if it will force me to sleep on my back w/o flexing my neck.
Had some interesting kids this week. Little Mr. Q is 4 y.o. but not in preschool, b/c mom can't afford it. I Peabody'd him, showing 10-month delays in object manipulation (ball use) and Visual Motor Integration. He jumps at a ball when you throw it to him, and thus, usually does not catch it. He also cuts with extreme forearm supination, which is the skill that tipped off the MD. I will be interested to see what the PT comes up with on Monday, and also need to tell Mom that Ollie's Bargain Outlet (one of my haunts) is carrying Pre-K instruction packs for $20.
Another child, Lil Mr. P, is an interesting story indeed. He was referred w/ a CP diagnosis, w/o his caregivers knowing it, and really does not match CP at all. I actually called the MD to make sure that he had written the dx correctly. What he does certainly have is dyspraxia, though the caregiver regarded me with extreme suspicion when I mentioned this and recommended Sensational Kids for further reading. (I like to refer to this book as I find it very informational and know that it is both at the local library and relatively inexpensive online.) Caregiver stated that he had an appt w/ a developmental pediatrician and that she would not make any more OT/PT appts until she had talked to him, b/c she doesn't think he needs therapy. Hopefully he will reiterate that Mr. P is not developing along the typical timeline and that he will need continued therapy, b/c he really can benefit.
That's about it for now... my parents are visiting later this week. I picked up the 2 headed crayons, but the RoseArt version, as they were only $2. I will also be making a list of projects to work on during the 3 weeks that my husband heads overseas for work. This really should include writing up some SPD stuff so that I can synthesize more of it in my brain, but also needs to have some tangible work for me to do. I'm thinking working out more, puzzles, artsy things. If I don't force myself to have a list, then I will just sit on the couch and do nothing.
Subscribe to:
Posts (Atom)