Thursday, July 31, 2008
I was thinking about that this afternoon....as one kid's idea of heaven - swinging and just a general sensory overload - would be my next client's idea of hell. Dante had it all wrong!
Week 5, Day Four, Peds OT Placement :) Extra boring rambles lol with no editing I'm too lazy tonight
10am: I wake up after going to bed at 3amish. Clean.
11am: my friends Sarah/Burt come over, Sarah just got her first car!!!!! Awesome!!! They ooh and awe appropriately at my new bed, new hutch, etc. We go to the Cupboard for lunch - yum.
12:45pmish: Get to work early to kinda get my bearings/settle in. Spend some time bugging Vanessa, the originally Indian/South African, PRN OT, who is really sweet and thinks I'm a "breath of fresh air", I guess she must live in a smoky world...;). She also thinks I should be an actress. Whoah.
1:30pmish: Observe session of COTA with visual perceptual/shy kid. So cute. I'm present to learn some "handwriting without tears" and provide some social distraction. I meet the Magic C bunny, and learn about the smiley face in upper left hand corner, and the bumpy handwriting types of paper, and the big lines, little lines, big curves, little curves (not "big fat bellies" as I like to call them). Learn about the chalk-board left-right, top-down writings, and just in general enjoy learning some handwriting without tears curriculum, I think it's a good one, and I think Crayola has hired an OT with knowledge of HWT, for their new products that are coming out all seem to be along those lines, ie the Pipsqueaks, short markers. I show the little girl my glow in the dark snail tattoo, normal snail tattoo, and dancing pineapple tattoo.
2:30pmish-3:15ish. Do paperwork, chill.
3:15pm: Start work with kid that is severely autistic, using SpongeBob on a timer reinforcement schedule. Am surprised and impressed when he points to the non-skid liner "blanket" I've been encouraging him to use to put SpongeBob to sleep, wanting me to get it, and says to turn off the lights....I've discovered through experience that the "Good night" game seems to be the easiest "pretend" game for kids to grasp, and serves as a stepping stone to other types of pretend...so I've been playing Goodnight Spongebob (blanket, turn off lights...good morning Spongebob, turn on lights, take off blanket) with him each session ...so was thrilled he initiated it today.) (He also stared very intently at my dancing pineapple tattoo)
3:XXpm: Get pulled into speech therapy office to speak to a parent whose daughter has just been put on the gluten/casein-free diet and is doing better, since I've read a lot about it and am a huge fan of Karyn Seroussi (sp?) book on Unraveling the mysteries of autism and PDD, and the dietary changes it promotes.
4ish pm: Re-take on Spongebob Kid, he is sitting in my lap and he starts laying his head back to kind of brush his face against my neck. After a few times of this, he kisses my neck. Then brushes off his lips with a surprised face. AHAHAHAHAHAHAHAA.
4ish pm plus a while: Craziness hits. The boss and my OT are in paperwork hell catching up on the last month and need my help. The COTA takes on some of my kids, plus has to "babysit" a kid whose mom is late, I also co-treat a kid with the speech aide, Haley, for about 30 minutes. She starts complaining she feels weird and so with the hypothesis her sugar is low, I get her a cold paper towel for her neck and wrists, get her some peanut butter crackers, and a water. In the meantime I can hear her discussing bugs with our kid. :) Then I treat him alone a while since time was up for her, it was a little boy with some autistic like tendencies, and he likes to mimic/go along with things said to him, and seeing as how I sing (poorly) made-up songs or just sing my sentences a lot, he was amusing me as he went along with what I would say and repeat it. A computer man came in and I was like "I bet that man is hungry, let's make him a strawberry (one of the cookie cutter pieces for Play-doh). I think I heard the man giggle. ;) We also made a "fence" to keep a mean biting bug out, with horizontal/vertical lines... I had no idea pre-handwriting skills like drawing lines were so important for kids!!
Oh, and Haley also sees a man for nervousness with speaking at work, and she had him talk impromptu about some things for me and the billing chick, Lindsay, he was kinda cute!!
The rest of the day - is spent - in intermittent thunderstorms - working on computers frantically working on old evaluations, plans of care (their goals), addendums for insurance, answering Medicaid questions, tracking down dates/billing/folders/notes/asking/answering questions, etc. It was truly crazy. I'd write up the eval/POC based on the folder, and print it, so my OT could review/make changes on it, then return to me to make the changes, print again, so she could sign it, and get it put into billing stack....I did several today and it was a good learning experience, and have hours to do tomorrow - I stayed almost an hour late until almost 8pm, tonight - then dropped clinical director off at home on way, stopped to get a cheap pizza, and got home around 820pm........now I'm lying here like a comatose vegetable typing this up for therapeutic purposes and then probably going to sleep soon.
Tomorrow is a home visit that my OT will do alone and I'm going to go straight to the office to finish typing up evals/POCs etc while she does that. The COTA and clinical director are coming in too so it's a paperwork catch up day. Only one other kid is scheduled that the COTA is going to see. My guess is I'll end up doing about 3 hours of paperwork but maybe less - I don't know though - we have a LOT to do. I think once tomorrow is over though, we'll be caught up and it shouldn't get that crazy again. In fact, I won't let it, at least on my end, because I really hate writing up evals/POCs on kids I don't really remember! All the info is in the folder, but still.
We have learned how to write goals in school that had like a million parts to them and were so precise and measurable and beautiful, but in this world, it's more like "Child will copy vertical/horizontal lines 5/5 trials. Child will improve safety awareness to fair+, 50% of time. Child will stack ten cubes 5/5 trials." - kinda vague, but whatev.
Tomorrow night the little baby that is severely delayed/deaf/blind is having a birthday party at Pizza Hut as she is turning 1 years old. My OT is taking her husband/daughter and the clinic director and maybe the speech aid are going to go as well. I'm thinking about joining them because it should be a very interesting experience - and I may end up taking home Lester the Lion Kitty - not sure yet. My OT called me tonight to say she found a blind puppy and did I think my low vision OT friend would want it? AAHAHAHAAHAHAHAHAHA
Anyway....day was intense with paperwork issues but it all went well overall, everyone is really flexible and nice. Sorry this is so long and boring but now my mind is clear. And I no longer remember what I did yesterday, so I can't write about it. Oh well. LOL.
Okay I think even though it's only 9pm that I'm going to get into bed. No exercise for me today I guess!! GOOD NIGHT
I need a kitty cat like a hole in the head, but you know, but not every day do you get the opportunity to inherit an inbred lion kitty that could win ugliest cat in the world contests, so we'll see. I think he could become a YouTube star.
I also think that Lester could become the mascot of pro-bulimia organizations, much like the pro-ana societies, because every time you see this cat, you want to throw up. It's that ugly. But just like space/time and hot/cold, at very special conditions, become one in the same, his ugliness becomes his beauty. So ugly it hurts. In a good way.
And before I get any e-mails telling me not to make fun of people with craniofacial abnormalities, or dwarves, or people with genetic deformities due to inbreeding, or people with eating disorders.......I want to adopt this cat, don't I?! (It belongs to my OT supervisor and don't worry, if I adopt it it will be post-rotation, so also, please no nasty e-mails from fieldwork coordinators telling me I'm making an ethically poor choice!!! Also, don't e-mail me telling me I'm too sensitive! Also, don't e-mail me telling me not to tell people what to write!! Also, yeah, just don't e-mail me unless you want to like, say something nice, in which case go ahead, but I'm as always behind on responding. Oh and don't tell me your cat is so-ugly-its-cute-er than MY future kitty...Lester trumps all cats. Period.)
By the way, this cat could probably benefit from occupational therapy - he is gravitationally insecure!!!!!!!!!!!!! He hates his feet off the ground and has to be held in a firm deep hold in order to tolerate it! OT is the cat's pajamas.
Speaking of pajamas, good night.....
A. W. E. S. O. M. E.
It's almost 3am, woopsies. Better go to sleep. More tomorrow about today, more tomorrow about tomorrow too! Ha ha ha. Get to sleep in a little, meet some friends for lunch, see patients 1 to 7pm, meet Allison to go walking, see another friend, blah blah blah, a friendly day. :)
Tuesday, July 29, 2008
See how different OT can be? Awesome blog, Cheryl
Another lady came in and only speech therapy had been ordered on admission, but I got a referral the next day. She was a little defensive about me showing up to see her, but we took a nice walk and discovered that though she'd been having trouble reading (a major barrier to her preferred leisure activities) she could still recognize symbols and was about 70% on reading basic words. I picked her up solely to educate her on low vision techniques that would make it easier for her to read (fonts, more space between words, high contrast).
Had a very unfortunate gentleman in his early 60's who had a bilateral cerebellar infarct with a 1-sided thalamus infarct as well. This man had just started a new job, so it can be assumed that he was a reasonably active individual PTA. Unfortunately, his current assests are moderate head control, moderate ability to hold sitting balance, and movement in his L elbow and hand. No current speech production, questionable ability to understand others, and a mix of flaccidity and extensor tone in different extremities.
Last guy came in with minimal involvement- some slurred speech, decreased endurance, and slight proprioceptive and sensory deficits. He will go home soon, but there is some question to the future. The PT tried to allude to this with him by saying, "This might be considered a wake-up call" but there is little hope of him changing the behaviors that caused the stroke to start with- obesity, HTN, no exercise, no checkups with doctors, etc. People can change after such events, my dad did after his heart attack and now starts the day with 30-45 minutes of cardio exercise and a cup of oatmeal. But in order to change, you've got to answer the phone on that wake-up call. Here's hoping that this guy does so that I don't see him in 2 months in worse condition.
Title LGT the American Heart Association.
Kerri is having a good fieldwork at a hospital in physical dysfunction!!! Some excerpts from her blog, sorry for the weird font.
This morning, I went in early (7 AM) (no outpt til 10) & tx on the floors!!! (in acute care in other words). Then, we had a full day in outpt care! I even got to make an outrigger splint for a pt - my first splint for a pt ever!!! It wasn't pretty but if you could have seen the guy's face when we put that on, it would have made your week! He was so excited to have a regained ability to open his hand to grasp things! He & I also got in a discussion about Wii games & how he could use his Wii at home to help with his rehab! It was awesome!
This is my last week as full time outpt. I will be floating next week between acute, NICU, & outpt (probably NICU & outpt mostly). I am superexcited to work with the itty bitty babies!! yayayayay!
Week 5, Day 2!!!
My OT called in sick today and at first (besides pity for her being sick of course)I was like AUGH KILL ME NOW because last Tuesday we had a thousand kids scheduled and it was a crazy day, and I couldn't fathom having extra kids....luckily when I got inside I saw her schedule and it was all evals + a home visit, so I was like phew - can't do those anyway - so her three evals and home visit were cancelled...
Then my second kid didn't show up, but the little girl who told me to draw a stripper last week, showed up. I was very careful to only work with her in open-wide rooms and did not touch her at all - she did want to close the door and asked about my tummy, but both cases I refused/redirected her. We worked on some big cutting and coloring and then she crumpled up all the work she had done. Instead of reacting I just calmly said hold on, we're going to glue it, and uncrumpled it and we glued it to a sheet of paper. Then I was like, do you want to dance and she nodded, so I pulled up the "crazy frog song" and started bopping silly. Well she looked at me for a minute then joined in, dancing like me, jumping around. WELL, THEN, some cell phone went off in the hall, a hip hop song ringtone, and she started gyrating! She was popping her butt out and shaking her arms the way you see the sexy dancers on MTV dance...sooo not appropriate. Luckily her mom was around (she came to get her to go early, transportation issues) and told her to stop. While I was appalled, I was also like damn, I wish *I* had those kinda moves! LOL.
I'm not so great at discipline, but I've learned one of my best weapons is simply not reacting at all. A lot of kids will do something solely to get a reaction/rise/behavioral response, and if you act like it was nothing or did not affect you, it loses its power. Of course if the child is truly inappropriate or dangerous I'll respond, but when I used to do play therapy with a really excitable little girl, I had to learn my poker face. For example, she would look at you, then deliberately spill her glass of water on her dresser, because she loved the thrill of a big emotional outburst. Not because she was evil, just because she was under-responsive to the environment. So instead of giving her the reaction she craved, you'd just go silently get the towel and clean it up and move on - so it was no fun. To anyone wanting to one day go into OT and especially pediatrics - I HIGHLY recommend searching for volunteer positions as a play therapist - there are always kids in every community who could benefit greatly from someone just playing one-on-one with them with the key objective to further their developmental abilities - it will give you great experience. In my case, my child was very under-responsive so I had to learn to be very silly and BIG!!! which was hard for shy lil me....seriously. I was reserved. Now I'm like JUMP JUMP JUMP LOOK AT ME! YAY!!!!!!! WOO!! GO GO GO! YAY LOL WOO! All because of Celia :) Okay that was my second tangent....oopsie doopsie....
I went to McAlisters for lunch with the speech aid Haley and the billing chick Lindsay...
In the afternoon I had my little girl with autism who says "Whooooahhhh" and now so do I because it cracks me up to say it...she did well with basic commands...then I saw my little boy with autism...then I saw my little boy with gravitational insecurity and he actually colored for like 45 seconds which was GOOD...then I saw my older boy with severe autism and he was agitated and neuro-ey, jerking around and wanting his grandma....so really a lot of his session was just tolerating being in his own skin and not freaking out. I also wrote a letter to Medicaid on why we shouldn't stop treatment on this one kid, being like, we use sensory modalities that provide calming vestibular and proprioceptive input to help reduce his level of hyperactivity which lets him focus on academics and blah blah blah, honestly I was like WTH, does this even make sense...but I'll let the OT check it out tomorrow. I also did my best to write up the two evals from yesterday. And I did billing sheets for the first time plus wrote my progress notes...I was like look at me! I'm an OT! LOL
I came home, met Allison to walk on the track for an entire hour - it's nice to walk at sunset and talk about our days - and then I practiced belly-dancing basics off YouTube for a while, like hip drops mostly. I'm a VERY slow learner when it comes to movement!! And I need a bigger mirror! Mine is long and skinny so I can't see my arms and that's important!!!
Now I'm lying on my tummy on the carpet because I'm too sweaty to sit down anywhere, about to shower then go to bed soon.
Tomorrow we only have a few kids plus our baby that is deaf/blind, then the afternoon is for like, organizational stuff, so maybe I get off early. Thursday is tons of kids but only 1pm to 7pm, and Friday should be 9pm to 2pmish, so YAY, the rest of the week should not be too much! That means I'll at half-way mark NEXT WEEK! GOODNESS GRACIOUS!!!!!!!!!!!!
By the way I spoke with Lindsay, a college student wanting to go into OT, on Sunday on the phone, for about 20 minutes. It was fun chatting to her and hearing the kind of questions she had - it was so broad - it reminded me of how confusing/HUGE OT seems when you first explore it - but it's sooo awesome because the options are unlimited, it's the most awesome profession - theoretically - EVER - in that you can help ANYONE! With ANYTHING! Theoretically, of course. Like every OT has varying strengths, mine certainly wouldn't be adaptive equipment!
Okay I'm going to go shower now.
Monday, July 28, 2008
Out-of-control child with ADHD, chiding another child (who had not done anything wrong): DON'T THROW THAT AT MY MOTHER'S HYSTERECTOMY!
This weekend was a little emotional/painful for me, LOL. I didn't do anything OT related or volunteer at all....had a lot of my mind. Saturday I was going to go do something but I did something weird and like, got Coke in the wrong pipe or something, and my tummy hurt for HOURS and HOURS and I thought I was going to DIE, and then Sunday I was just very much blah. I saw some friends this weekend and that's about it.
Today was off to a bad start as well as there was some timing miscommunication but it worked out overall. We had some chaos this morning though - I tried to have two kids together (one of the kids was done with the session and I just wanted to use him for the other for social interaction while he waited for his mom anyway), but I didn't structure it well. My OT then put two kids together and structured it well and I watched and learned a lot.
We also saw a one year old baby that is blind that lives out in the middle of nowhere, and saw our typical baby that is deaf and blind, and then there were two evals + three other kids...all at the new clinic or in that area. Growing really big really fast.
I got home, napped, and then walked with OT Allison for a while on the track....now I'm burning CDs while my hair dries and did about 70% of my kitchen cleaning, LOL. I'm not really feeling the whole therapeutic blogging thing tonight - just not in the best of places - tired, a little stressed, a little worried because I think I might have angered my OT but not sure why, and just in general, not feeling perky. I'm supposedly helping Allison write out her group protocol via online AIM but she doesn't seem to need my help that much! LOL
And now for an IM of delusional proportions from my fellow New Jersey OT student friend, goodness gracious nooo:
Sunday, July 27, 2008
Somehow I think I'm going to be really lazy today....was up a lot during the night feeling yucky...now it's noon and I've been up 20 minutes but I feel like going back to bed, lol....
Saturday, July 26, 2008
Friday, July 25, 2008
Yeah. Not gonna happen.
Thursday, July 24, 2008
Today was awesome because I got to sleep in ridiculously late (although forgot to take my meds and have had a headache all night because of it)...and then I had my little girl with visual perceptual issues....I got several smiles out of her today...she is so cute. We worked some on her writing her address, and her handwriting is sooo atrocious, LOL...we also did some worksheets on VP from edhelper.com, some of the C D B book, a new Peeps puzzle, etc...
Almost every kid in the world cancelled today which is crazy and rarely happens - so I only had one other kid - one I haven't seen before - a little boy who needs a lot of basic help and probably has autism - Christy my OT says he has good days and bad days, and apparently i got him on a good day, because after a few minutes in the ball pit and with the tunnel, I managed to keep him strapped in at the table for the next like 40 minutes, with the busy bugs - we walked them back and forth on the table a while talking about colors, then we would put them away, tell them good night and turn off the light...wait a minute or two, say good morning, turn on the light, dump them out.....repeat...lol...then we added in some variation where I dumped the bugs out in the night and then we'd turn on the lights and find them out of bed, put them in time-out for one minute, etc. LOL....I was in a sing-ey mood and he seemed to like it so I would sing things like "Grasshopper jumps in the air, grasshopper jumps into your hair.....ahahahhaha. Who wants to sponsor my voice lessons so I stop shattering eardrums?!!!
Then Haley, the really way wonderful speech aid who will kick graduate school butt, came in for co-treat, and we worked with him on finding certain colored bugs and then certain colored "food" for the bugs, to work on coloring and counting and stuff...she is awesome. She just Facebooked me to tell me to put on more pictures but the problem is that I can't include kid's faces - I think I may start taking two types of pictures - not just website-worthy-picture-form-release worthy ones, but also blog-worthy ones from the back or sides so that the kid isn't recognizable but the activity is. :O
The only other kid we saw was a kid who has a lot of difficulty with self-expression and emotions labelling, so really his OT session involves a lot of psychology...my OT did an art therapy session with him where she would draw a line then he had to make something of it, taking turns, and then at the end they labelled it as well as discussed things about it...she wanted to work on SCARY things with him and to discuss what is scary and how to deal with it, and we ended up with a list of things that are scary for me, Christy, and him (mine included loose teeth, storms, water, and rollercoasters)....it was a neat session to watch as Christy extracted things from him. I tried to lay low in this session, at least for the first part, so that I would not be a distraction.
So basically instead of 9 kids we only had THREE...which is crazy. Nice though too, although spread out enough that I still didn't get to leave early really :( Oh well LOL
Then I went to the grocery store, made dinner, and have been sitting around at home ever since...cleaning, organizing, chilling...very tired. ....I bought some chicken pieces, some reduced-price-old (?) rosemary potato bread, then shredded up the chicken andbread, crushed in some baked lays potato chips, and sprinkled some corn on top...it was yum...a chicken-corn-chips-bread collage....too bad bread doesn't start with a C or that would be an awesome name. I guess I could lie and call it crust so I could have chicken-corns-chips-crust-collages, or 5C for short. Just kidding, I'm delirious. ANYWAY....I usually eat peanut butter crackers, frozen cherries, or some other random assortment of food for dinner, if left to my own devices, so having real food - including protein - is like miraculous. Woot woot.
Okay anyway. I'm TIRED. Will blog on Wednesday + newest emails + Facebook stuff later...plus I so badly want to catch up on OT blogs and share a bunch, and well, ugh, there is not enough hours in a day.
Friday makes FOUR weeks....1/3 of the way through first fieldwork...which is crazy.
Tomorrow we start with a home visit, then I have three hours of kids, from 1030 to 130...well really Christy is scheduled for those kids but that means they are mine....I hope the last kid doesn't show up, I have not heard of him before but I hear he usually doesn't show up!! The home visit kid and the first clinic kid I know, but the second kid I've only heard the name of.... Then I meet a friend around 3ish and then I hang with Kerri & Brent and then I might be joining some of the MOT Class of 2009 for an outing....it starts with the South Main trolley tours of downtown memphis but we'll see, I may be too tired for that, and may just join them for seeing a movie at the drive-in, since I've never gone before!!
This weekend I want to hit the Alzheimer's Daycare center on Saturday for a few hours to chill with old people, hit LeBonheur to hold babies a few hours on Sunday, do some belly-dancing practice, and see a ton of friends. Plus try and rest some in preparation for another week. Oh, and I need to go with my landlord to go pick up some stuff. And my landlord's friend is going to fix my leaking air conditioner, etc. Yay. Woot. Okay. Did I mention I'm going to sleep. Yeah. Good night luviepoos. Don't let the busy bad bed bugs bite. Alliteration is awesome.
Oscar Pistorius is a double amputee from South Africa who wanted to be in the Olympics but the IAAF says his prosthetic legs give him an advantage....well maybe in some ways (like independent studies showed he has to expend less energy overall) but the pain tolerance needed to run on those legs, has to be STAGGERING....I personally think the DISadvantages of running with prosthetic legs are enough that it counter-attacks any advantages, but I dunno. Just thought it was interesting to think about...
I picked up a sample of Chewy Tubes - "Oral Motor Device to develop biting" - while at AOTA conference. The other day the SLP (speech therapist) put some rice cereal on it to allow our little baby that is deaf/blind, start working on real food, as well as lose some of her oral motor defensiveness. It was neat to watch the baby experiment with this pliable thing in her mouth. She tolerated it very well.
I have a book I stole from Mom called "C D B" that is really more geared at adults, but I think it can be helpful in OT, and I in fact used it with my visual perceptual girl today, on some of the easier pieces...just to see how quickly she could recognize/read the letters. I even got a few smiles from her :) It's a book using just major letters - like, for example, the first page shows a person looking at a bumble bee, saying,
C D B - D B S A B-Z B.
Here is my friend's country version of C D B, lol, he had to read it to me with a thick accent the other day and I already forget how to interpret some of it:
C M R DUX
M 8 DUX
M R 2 DUX
C M R WANGS
L I 8
M R 2 DUX
Animalia is another awesome book for visual perception but it's again more geared at older kids or adults....each page has its own letter of the alphabet, and the pages are breathtakingly done, filled with HUNDREDS AND HUNDREDS of items starting with that letter...it ranges from the basics - like a butterfly for B - to very obscure items starting with B that only a really smart person would even know the name of. It's pretty awesome....I love it.
I got these from Reader's Digest and they all struck me as exceptionally funny so I'm sharing....
"I have CDO. It's like OCD but with the letters in alphabetical order, like they're supposed to be."
Q: What did the airhead name her pet zebra? (maybe the airhead has visual perceptual issues)
Q: How many ameobas does it take to change a light bulb?
A: One, no two! No, four, no eight...
Cartoon: A hermit crab with no shell to a hermit crab with a shell, on a beach littered with crab shells: "I forgot where I parked."
Ok time for my OT-related posts then bed-time. Early night. Tired.
Wednesday, July 23, 2008
830am - 915 to clinic...saw 1, 2, 3 + baby
1, 2, 3 kid counting - boy
House/groceries/colors/restaurant/at service , after lunch - boy + bro
Communication breakdowns = in general lol
hip rotation/knee hyperextension - girl
meeting other karen , lunch
eval - come to house, borrow truck - balls - visual perception - cherry bomb x 3 - done 530pm - need to write notes though for 1.5 days now AUGH - - friends house for dinner and kerri/brent's, med stuff, stories hmm, tomorrow until 1pm, chiro shearing forces lol, groceries, blah blah blah blah whatev
Tuesday, July 22, 2008
PS: I love getting e-mails, I'm just slow to respond and end up having to write short responses, I am sorry....
PS2: Facebook responses will be tomorrow's much easier goal :)
Tuesday, July 8, 2008
Our first unit covered the thorax, the neck, the face, the head, the cranium, the abdomen, the abdominal contents and the posterior wall. I thought that was a lot of information but it is no where near compared to the amount we have to study right now. My suggestion is the go to the lab when you can, in reasonable increments. Don't spend hour upon hours in there because you will definitely go crazy. A little bit a day is the easiest way to do it without being really overwhelmed.
The unit we are on and about to take a test on this next Monday is the back and the upper extremity. This unit is way more intensive and many of us are at our braking points. There are so many origins, insertions, innervations, and functions to memorize it is nearly impossible in the short time that we have. This unit has really been a struggle and most classes in the past have done the worst grade wise on it. I just want it to be over with so we can move on to the lower extremity, which will be the last and final area we touch.
AOTA Victorious in Medicare Fight
I somehow happened upon your blog. Enjoyed reading some of your entries. Its
very interesting to hear of your studies.
I noticed you had a link for some visual perception exercises.
I maintain a simple blog at www.creativespectrum.blogspot.com. I am a mom to
an amazing little boy with Autism and I am also an artist and eventually
thinking of studying Art Therapy. We are also working on a coffee product
called yummycoffee.org (for Autism). Check it out -if you drink coffee!
So I keep this blog on creative ideas for those on the spectrum. I often
include links to other articles and info that I can share for others. I just
like to post anything I think is relevant or interesting to share.
I want to include your info about the visual perception link, and thought
maybe since you are "studying" that you might know of more resources that
you happen across that could be available to parents. And/or if you wanted
to write something - I would be happy to link to your site.
Well thanks again for sharing.
256 6th Avenue
Brooklyn, New York 11215
347 342 8838
Do you think the definition "FRIKKEN AMAZING" would work?
The 5th edition of Quick Reference Dictionary for Occupational Therapy (SLACK, Inc.) edited by Karen Jacobs and Laela Jacobs is coming! For this latest edition, I have been asked to develop an appendix to help answer the question, "What is Occupational Therapy?" Every student and practitioner has been asked this very question countless times. This appendix provides both professional and practitioner/student definitions of the profession and are designed to serve as a tool for readers to assist those not familiar with occupational therapy understand what we do!
I am in the process of collecting one-sentence definitions of occupational therapy and you can help! This is your opportunity to share your knowledge about the profession and if your definition is selected, be cited as author for that definition in the newest Quick Reference Dictionary!
Please forward your responses to the following email address smcneil AT bu.edu no later than Friday July 25th at 6pm!
Thank you in advance!
Scott D. McNeil, MS, OTR/L
OTD Student - Boston University, Sargent College
I probably should have posted to the other link but a post is a post. The Dollar Tree or 99 cent store is a great place to find tactile little tsotkes and if you can take the time to wash them, things at garage sales work as well. Just make sure that you sterlize them!
Also, make sure they aren't TOO small that kids can't put them in their mouths. Er, and make sure there isn't any lead in it either... I think that covers it. Thanks again for the shout out for my book, "Your Daughter Has Been Diagnosed With Rett Syndrome" a few months back. Good luck with your career and definitely don't go broke!
The OTnow.com site has two wheelchair-specific resources:
1. The FEW (Functioning Everyday with a Wheelchair)
2. Wheelchair Evaluation (created by myself)
Most of the resources, but not the
FEW, require a password.
Please go to the following page: www.otnow.com/resources.html. If you
need a password, follow the directions on the page.
Hi Karen, my name's Mark. I'm 17 at the moment and im currently in my final year of studies before hopefully going to University of Queensland, in Australia. Basically, for a long time during almost all of high school i couldn't decide at all on any career path whatsoever that i wanted to take, which was pretty depressing LOL. Until eventually my girlfriend's mother set me up with one of those occupational tests that tells you what sort of jobs match your personality and interests the best, and Occupational Therapy came way above anything else for me which was pretty suprising (seeing as i had no idea what OT was) but pleasing once i found out :P.
Ughhh so basically I've done a little bit of research on the courses and so forth and I'm taking quite an interest so far, and then i stumbled across your blog which was exactly what i was looking for, i thought it was an awesome idea for you to talk about your experiences in the field and during your studies because that's exactly the opinion people inspiring to undertake these courses needs to see, so they don't waste their time haha :p Anyway I haven't managed to get through the whole blog yet, but I was wondering if you could possibly reply to this email and tell me a little bit about the course and whatnot, like the Ups and Downs of studying, how full-on the studying was? if that makes sense :S what sort of jobs you've had sent your way and so on.
ANYWAY yeah I just dont feel like all the technical ramble on the internet about OT does it justice, so I figured I'd set out and try and find someone who could give me a brief rundown on what to expect, i know I can get the grades, i just need the motivation :) haha, so thanks for reading if you got this far I hope you manage to reply to this and keep adding to your blog :) i'll be checking it regularly ahah.
that's quite an observation you've made. i'm proud of you. many people speculate that "big pharma" is who lobbies hardest against natural treatments/cures. watch michael moore's "sicko" with your friends. you are all entering a very challenging field in which to work -- healthcare. resources are scare, prices are high, compassion is low, and ignorance is plentiful. yet, you can and will make a difference. you truly were meant to be an advocate for people who can't advocate for themselves. i still hope you will somehow go on to receive your doctoral degree. in my estimation there is no limit to what you can accomplish. you are a born healer and a born diplomat. :) i am so very proud of you.
Wiki stix are wonderful. Try them to figure out the maze in the Little Pony Book rather than drawing a line.
And instead of purchasing raised line paper, try using the wiki-stix to create the lines on blank paper (or lined paper)...I hate the idea of you spending your private money on your fieldwork patients. It's wonderful and generous but I would recommend that you set boundries for yourself...
Regarding her shyness, perhaps use a "third person"--a little doll, pony, teddy, whatever--that speaks to her and asks her questions, rather than you speaking to her directly and she speaking directly back to you. It is amazing how much easier it is to relate to a puppet..
I think I worked about 50 hours/week during my fieldwork placement, plus fieldwork assignments and my research project. It bites, but when people are paid on salary, they often stick around longer than their students would like!
NYU Grad has left a new comment on your post "Week 3, Day 1, Pediatric Level II Fieldwork Placem...":
The majority of my class want to go into peds, giving the general justification "you get to plop on the floor and play with kids all day." I'm interested in early intervention part-time, only because I don't think I have the energy level to be "upbeat" all day long. lol
Have you noticed burn-out yet?
People who say you plop on a floor and play with kids all day have no idea what they are talking about!
Working with kids DOES require energy!
I haven't noticed burn-out but it does exist just like anywhere else :)
Pay no attention to the anonymous Jack*%$! He's a coward who has nothing better to do than criticize someone who is trying to help others students.
He needs a beat down followed by OT intervention to restore him to full jack#@^edness!
Mind Body Shop has left a new comment on your post "Week 3, Day 2, Pediatric Fieldwork, my first day o...":
Nothing is more important than the person inside. Therapy exits for the person inside; it has no other purpose.
AMEN MIND BODY :)
I want to write about two awesome case studies that Level II fieldwork students presented on their low vision rehab rotation, because it was really neat, but I lost my one page of notes and I don't have the Powerpoints, so until I get access, um, I'm unable to talk about it!
1) I saw a little girl (like six-ish?) with SEVERE adhd today...I wore her out with some "heavy" joint compression work like pushing me in the office chair in the carpeted halls, then we worked on tracing letters and basic writing skills, while prone on the floor on tummy with slanted surface....she kind of freaked me out because she always wanted the doors closed and kept asking about locking it, and she kept pushing herself at me wanting hugs, but was really aggressive about it. I know a lot of kids have sensory needs and she needs a lot of input, but there was something off about her. Which was confirmed when we were drawing and she said, clear as day "Draw a stripper!" I said "I don't know that word" and she said "STRIPPER!" And I repeated deliberately, "I don't know that word. How about I draw a bubble". I really emphasized the word bubble (we were working on circles)... AHAHAHAHAAHAHA. She looked at me like I was the biggest dumbass on earth, but let it go.
2) I saw my shy little girl with visual perceptual issues and severe sensory processing deficits...we did a word code thing where you match like numbers and letters to read a code...and we wrote a letter, I need to put a stamp on it...but I pushed her today. We have a big hammock swing in the doorway only a few feet off the ground but of course being off the ground period, if you have gravitational insecurity, is a huge deal. I encouraged her to get in it and helped her, and she was almost frozen with fear. I was at eye level with her, holding her, promising her she was okay and making sure she was okay and all that, and I had to put a chair in the doorway so that she was LITERALLY sitting in the chair, in the swing...I had her throw these little farm animals she loves, down into the tunnel (I'm telling you, tunnels are magic OT tools)...she liked this and had a hint of a smile on her face doing this, but was very much tense, even with the chair underneath her. I didn't even bother trying to swing her that's how scared she was...and I wanted her to not be deathly afraid of ever getting back in. I eventually kind of moved the chair away but kept my hands around her body, like literally wrapped around her, and she tolerated this for only a few seconds...she clearly wanted out so of course I agreed, but the getting out part was the most traumatic. She was truly petrified. She was 100% safe within this hammock swing, a few feet off the floor and not moving, but scared out of her mind at the idea of me letting go of her at all to adjust to be able to pull her out, or even be able to re-grab the chair...luckily Haley, the speech aide, has an office right by the room, and so I said Miss Haley, can you please come here and help me with Taylor, she is safe but really frightened, and I'd like you to put your arms around her in the swing so she feels safe, while I move this chair back under her...so with Haley's arms around her I moved the chair back underneath her and she was SHAKING in fear even though both of us had her arms around her. I didn't push her again and let her just play with the animals on the ground, although I did get her grandma to show her how brave she was (the session was up), and then encouraged her to get on the rollerboard for the walk back to the waiting room...which she did with no problem, so she wasn't too traumatized.
Haley was shocked at how scared my little girl was at the swing...I was surprised a little bit at the intensity, but could understand it, and I'm not sure exactly if her intense fear is such that I shouldn't even try it again, or if I should encourage it, or if there are better steps before doing the swing. I don't know. I think I'm going to encourage it and if she is adamant, I'll back off, but I get the feeling she'll try again relatively soon...and I'll try a few other gravitational challenges of a lower degree, in the meantime.
I was proud though that I could stay calm and not get panicked/anxious that she was so scared, cuz I could have been like AUGH she's freaking out AUGH get her out, quickly trying to pull her out..which would have escalated the situation and scared her more.....if you watch physical therapy on someone who is in a lot of pain, the physical therapist has to learn the slow controlled movements and the poker face....even though the PT may be like OMG this is freaking me out, the PT can't just let go or look panicked at the screams of a client...the PT has to look as if nothing is wrong. I used to watch the PTs at St. Jude work with kids with osteosarcoma who had limb-sparing surgeries, and the kids would be screaming and crying, and the PT just had to keep slowly pushing...wow. Intense. Not that this compares physically, but mentally, whoah.
My random day:
Today I left my house at 8am and got home at 9pm :) I got a text at 8:30ish asking me to start my OT's 9am kid because her daughter was sick and she would be running late. Luckily, her 9am client and my two 930am clients, are all one family - triplets - and they didn't show up - so that gave me a little extra time to start the day, since I started with Christy's 930am kid, an adorable young boy we'll call Bob. He has horrible body schematics -(jumping jacks are very revealing tools), and visual perceptual issues etc....it took him about 10 minutes to do a basic 24 piece ocean puzzle.
Saw a little bit of little girl with autism who always says "Whooooah" and she reminds me of one of my favorite people because she says things like "Fish?! i LOVE fish!" LOL....saw a little bit of a little boy with various issues including major lack of safety awareness and impulsivity and is quick to apologize then repeat the incident. Saw my kid with severe autism and we did a mixture of SpongeBob + various activities like matching, puzzles, blocks, etc...
Did some worksheets/puzzles with a little boy with delayed skills...saw a kid with Down syndrome who makes me feel like I suck as an OT because it's like he slips through my fingers and never gets any "work done", saw a little boy with severe ADHD and did a lot of trapeze swinging/hitting balls with his feet...saw a little boy with autism who seemed extra calm today and his parents reported they had just started him on fish oil...he normally wants to spend all his time in the balls but today was better about not being in them...BTW, he and several of the other children with autism we see, seem to do remarkably well, social interaction/eye contact wise, when using a tunnel...the kind you crawl through....like the kid sits in the ball pit and the other person is on the other end of the tunnel, and i dunno, somehow it helps the kid focus...I guess since the tunnel is kind of like blinders...and extra fun...
Okay a few other random tidbits...I had to dispose of a decomposing bird the other day at the clinic...which included my OT and speech aid shrieking and hiding AHAHAHAHAHAAHAHA ....it was sooooo gross.
Also, my friend Virginia who is working with a TBI who loves KISS, printed out some pictures of KISS, and today he tracked with his eyes for the first time, with that picture...and they have a few KISS mp3s to play for him now...one of which is thanks to one of my blog readers, who is really sweet and thank you so much!
I left work around 7:20pm after seeing a total of a thousand bazillion children...I still have a few notes to write but I was like dude, I've been here 11 hours, I'm going home...and crap, I forgot to get my medication refilled, I just remembered. Oh well.
Oh, and I have no idea what tomorrow will bring, but I do know it involves a visit to our new clinic, so it probably involves about 4 kids in the morning plus two kids in the afternoon plus a few evals, I guess. I don't know exactly.
I went straight to UT dorms to visit my OT friend Allison and we went walking on the track with her DPT student roommate....who talks about "spondylos" and "vertebral body fractures" and "shearing forces" nonchalantly, LOL.
I had a piece of cheese, frozen cherries, and Baked Lay Chips for dinner and I'm about to go jump in the shower, then answer OT e-mails while my hair dries, woot woot.
I had trouble falling asleep and had to use Myoflex on my back + took half a hydrocodone, which I try to never do!! Then I woke up wide-awake at 4am only like 3 hours later! I tossed and turned until 7:20!! Ya gotta love just having a few hours of sleep!!! Woot adrenaline!
Just had my yogurt/frozen cherries/sliced almonds, about to gag on about fifty thousand supplements, have a big ol' fistful of stickers and visual perception/handwriting worksheets I printed out yesterday, plus am bringing a heat pack, a cold pack, biofreeze, and painkillers for my back. I AM READY TO FACE THE MUSIC! I want to get there a little early but not too early since I don't have a key to the clinic!! I'm going to pull all my morning kid folders so have access to their goals to be working on, have a few of them already prepared worksheet wise, and then do my best to not freak out with the insanity. AHAHAHAAHA
Plus I'm starting to feel bad about the lateness in responding so my official only goal for tonight post workout is just to respond to my e-mails and facebook msgs!! And write some cards, I'm so behind on my lonely-people project!
Have a good day!!!
Monday, July 21, 2008
1. Organized files/folders this morning, felt soo good and cleansing to my soul.
2. Did my first two evals- with mod-max assist by my OT, LOL..... - using the LAP and ELAP (learning achievement profile I think it is), which uses + and - marks to look at things based on kid's age in months, ie stacking 10 cubes, turning pages in a book, picking up small items with tongs, etc. I've watched her do it multiple times but I found it slightly more complicated than I was used to, but should get alot easier. I needed some help figuring out some of it and I know y'all must be like what, you are just doing your first eval? But remember A) life has been CHAOTIC and B) I've had a full treatment schedule for a long time now so I haven't had a chance!!
3. Saw my little gravitionally insecure kid - who signed "ball" today and that is an awesomely big step - he was kind of a pain today
4. Saw a new kid today - had him lie on his tummy and do handwriting exercises on slanted surface board - did quite well - he made a letter "float" though by not grounding it on the line and I drew little wings on it and said that letter is flying and we want ground letters. Later we ran out of space and I told him to go ahead and make the letter float in the sky and he added little wings like I had done, LOL
5. Went to tiny new clinic with my OT and a speech aid Haley - it was fun - my clinic kid is doing better and better being consistent with colors, and we started work on D's and C's today - just because we were drawing dragonflies nad caterpillars - he interestingly can draw the leters, but not in the right orientation - he drew them sideways/backwards, but hey its a start
6. Saw our baby with deaf/blind issues and I mostly observed while speech aid helped with positioning - I was jealous -but my back has been re-tweaked and is KILLING ME...i have cramping pains going through my thighs from my back :( So I didn't want to be doing a lot of bending/leaning etc. Ugh, it hurts. The baby did a great job today though and tolerated standing/weight-bearing for multiple minutes :) It's such an interesting situation being there in the housing projects and watching the family interact - a lot of "BOY, YOU GET AWAY FROM HER OR I AM GOING TO THUMP YOUR BIG EARS"... lol. It's sad, but I refuse to think about it! Working with babies is the most intuitive to me - it REALLY makes me happy and while I am by no means an expert obviously since I'm just a baby student, it just seems the most awesome and easy to grasp.
7. SAW THE UGLIEST CAT IN THE ENTIRE WORLD!!!! It had massive inbreeding issues and since its face is like, smooshed up like it was hit with a shovel and its mouth doesnt close right and it breathes funny, it can't groom itself, so his family (my OT's house), has it groomed in a lion cut, so its face, paws, tail has poofs of hair, but its body is shaved, its like a Siamese lion and its SO UGLY I COULD DIE. I wanted to borrow it for like 2 months so that I could look at it and vomit whenever I felt like eating, and then once I lost enough weight, I'd return it. It was actually so ugly it was kind of cute and I kind of liked it in its ferocious ugliness.
I got to leave by 530 pm today (only 30 minutes late...pretty typical), and then went home and napped several hours...was going to go walking but my OT friend Allison didn't have the best day, LOL. Then another friend came over while I cleaned/organized...
Tomorrow is going to be an INSANE INSANE DAY. I have ELEVEN kids scheduled between 930am and 7pm, and since my OT's schedule is usually insaner than mine, I'll probably have her 9am kid too (making twelve), so with the exception of lunchtime, it's a SICK day. No breaks between kids...I promise you I will not get to sit still at all. And when you factor in the cramps of my legs and my back pain, it's gonna suck, LOL. Plus my OT has a parallel schedule, we don't share any kids and sometimes she has two to my one, plus the tech has one in afternoon, so at times there will be 3-4 kids present...luckily I've seen most of them before, I only have one kid I have never seen, and two that I don't know well...the rest I have regularly. I most look forward to my six year old girl with visual perception problems, social issues, gravitational insecurity, etc etc ...I printed out a bunch of great worksheets, plus I want to try and get her in the swing if things aren't too crazy (she'll balk if there are other kids around).
Overall I'm not too stressed about tomorrow - the only thing that really stresses me out these days is having multiple kids at once, esp if they don't match up well or I don't know history - but I shouldn't have thta issue if all goes as planned (yeah right) - mostly just worried about getting through the day without heavy painkillers, LOL....but afterwards I plan to head straight to campus to go walking on the track with Allison.....Wednesday I'll possibly see some other friends too...Thursday I'm going to go watch OT friend Virginia play volleyball ....etc :)
ANYWAY....I better go to sleep seeing as how it is almost 130am and I have to be up in six hours and then go zoom zoom zoom all day long!
OT people who have e-mailed me, maybe tomorrow I'll answer your emails?!! Sorry it's taken me so long, I'm a hideously bad person!! Just kidding, I'm supposed to not work on being self deprecating. But I'm bad at that too. Oh wait I did it again. See I told you. Oh wait. AHAHAHAHAAHAHA
I do swear I always respond :) Just at a snail's pace these days...there are not enough hours in the day. Last night I was out in Germantown getting gas at like midnight after saying goodbye to my friend Doug who headed back to England today!! Okay okay BED TIME
Pictures: One is of me and billing specialist Linda who is hilarious, and one is of town square of new clinic in tiny Mississippi town :)
The ball bath, I swear I spend like half my days in this thing.
This is NOT a client but rather a friend's child....at the time of this picture he was 3 months old. He does this very interesting thing where when he wants to reach for something carefully, he brings his hand to his face at midline, then reaches out from that point...my friend said her older son (who is like super genius awesome boy), also did that. Anybody else ever see this before?
Little boy doing AquaDoodles in our small OT office...he obsessively copies out a Fox DVD cover with the serial numbers and everything, like ECQF4 etc. ....
The bag of Early Intervention toys we use a LOT.
1. Coloring books for Adults good for use for picking out shapes
2. Drawing on a kid's back and having her draw it on paper
3. Joyful noise, book of duet poems
4. My fingernails on a worksheet :(
5. Raised bump paper + a finger grip
6. Uppercase letters + red construction paper filter so less visual distraction
7. Catalogs I want to look through for ideas for VP items
8. Books I want to look through for VP ideas. Key word "want" LOL
9. Belly dancing stuff - shiny and loud and potentially cool for treatment!!!
Saturday, July 19, 2008
Also, we have a lot of Medicaid parents or parents living in projects who could use baby toys...or exer-saucers, or sterilized bottles, etc...many of these parents have NO TOYS at all for their kids. So blocks, etc...are awesome. Also the small $1 items in the bins at the front of Target are often great - like right now they have these tiny little pouches of plastic animals and I should really go buy some more because they can be used for so many things - basically those of you who read this that are occasionally in the Memphis area, please consider saving or collecting baby toys that can be donated....or even normal toys...
I've had a lot of dreams about OT things...like I dreamt about putting the belly-dancing finger cymbals ("zils") on a child the other day...and I dreamt about buying this family a bunch of clothes at a Goodwill although this one aardvark t-shirt was so awesome I wanted it for myself...just a lot of dreams where I am wanting to get stuff for people....it's so hard to see people who have nothing...and to want to just empty my bank account and buy them the world...but it's a slippery slope. Ugh. Anyway, keep your eyes peeled for creative ways and things to do...it all helps, every little bit.
Thursday and Friday, July 17th/18th, Week 3 Day 4/5 of Pediatric Fieldwork Level II Occupational Therapy Placement
I wear my new blue-ish undertone pink lipstick - my first ever since I always thought I looked like a cyanotic zombie but apparently I don't - that my OT friend got me as we are working on my makeup skills - and everybody told me how bright my face looked and stuff, so apparently it took 25 years for me to get the right color lipstick. I love my friend. Yay!
I was really, really, really, really proud of some of my OT skills today - it wasn't a perfect day and I was frazzled or unsure at times, but I had several great sessions. :) Which I'm about to share in mind-numbing detail!
Layla, 1 hour: I was ready for her based on the informal visual perception (VP) lecture I got from my OT friend the other day after I went home so stressed out about what VP includes and how to treat with a kid. She is a six year old that is cripplingly shy and has severe VP issues. She is repeating kindergarten. I'm going to end up inserting pictures into this post later of some of the things we did - pictures of the worksheets that is, not her. Sorry.
We started with some basic sensory stimulation - I don't know if I'm necessarily doing anything helpful here, but I figure it's a little playful, which she needs, and that it probably doesn't hurt any to give her hands a little input. We pat our hands, clap our hands, rub our hands, I use a vibrating tool on her hands/fingers/palms, we shake our hands in the air, wiggle our fingers....then we're ready to work out our hands with writing.
PICTURE 1 - PENCIL GRIP
First I gave her a pencil with a pencil grip on it - I like the one shown her because it forces the fingers into a good position but apparently the COTA Miss Charlene, who is a handwriting guru, finds them too restricting, so today we used one that only emphasizes the two main fingers and doesn't have an under-part for the middle finger. Also, the shorter the pencil, the more likely it is the child will hold it correctly, and will also have better control, if you hand a kid a normal sized pencil they tend to hold it closer to the top than bottom (if the kid is a struggler). I want to try out the new Pipsqueaks - short markers. I wonder if Crayola has an OT working for them. They are a doing a good job coming out with helpful utensils.
PICTURE 2 - BACK DRAWING.
I got this idea from my OT friend. I drew lines in various ways on her back, then a circle or two, and some shapes...she had to draw on her paper what I drew on her back. This is complicated for a child who struggles with VP issues - translating the feeling on her back - interpreting it in her brain and sorting it out so that she can then visualize what that was and then give her fingers motor output commands on what to draw. Lots of steps. I butchered the neuroscience of it but you get the picture.
Then I gave her a drawing I copied from one of my two adult coloring books - I wanted her to pick out five circles, five triangles, five stripes etc, and color them, from this very visually distracting picture.
PICTURE 3 - ADULT COLORING BOOK
Then we used wiki sticks - which are like tiny sticky pieces of like, waxy yarn, I don't know, that are really pliable - to have her make shapes out of them. We did like four. Then I had her use AquaDoodles on the wall - a vertical surface, just for a minute . Then I really wanted to do a poem from the book Joyful Noise which are duet poems, but I realized that even though she reads well, the vocabulary would still be too hard. I think I'm going to make her an easier one at the suggestion of my OT. I think it's a great way to work on social cooperation and playfulness.
PICTURE 4 - JOYFUL NOISE
PICTURE 5 - RAINBOW
Here is a picture of the rainbow she drew for me the other day and the nail polish she gave me on my fingers, LOL...had to put it in somewhere.
PICTURE 6/7 - ALPHABET + FILTER.
Then we worked on a simple maze in her my Little Pony book - she could not do this to save her life - am not exactly sure how to coach her on this? Hmm.
Finally we got to work on the hard stuff - handwriting. She tends to shrivel up her handwriting, so that her bellies look like raisins and her sticks are all osteoporotic, bent over and shrunk. I would verbally coach her to make sure her lines she drew hit both top and bottom line, and even show her, but somehow this was really really hard. Here is what we did - I gave her a sheet of lined paper and made the top and bottom lines extra thick with a Sharpie. Then I had her write a capital letter alphabet from memory, one at a time. For example, she did the letter A. Then we'd look at the letter A from a worksheet- using a red filter i cut out so it was less distracting - and figure out how to make it better, so that she'd end up doing it again with those verbal cues. At first nothing seemed to work to make her hit the lines properly, but by the end of the alphabet, she was doing awesome. But I've been really thinking hard about fun, NOT drill-y, ways to work on hitting her lines top and bottom...I think I'm going to bring in raised bump paper next time and ask her not to stop the line until she hits that bump.
Finally it was time to go. We have a big round rollerboard that I asked her to sit on Indian-style, I mean criss cross applesauce, LOL. She was hesitant. I hadn't realized she had gravitational issues either, but she was rather terrified. I encouraged her and let her know I would go very, very, very slow. And I did. I very very very slowly walked her, her on the rollerboard, into the waiting room. When she saw her grandmother she smiled faintly, but that was her first smile on that board...she was scared...but I think I can get her to get on that board each time we go into the waiting room and with time I bet she'll even like it. In the waiting room I gave her handwriting grip to her grandmother, showing her how to put it on a pencil and how Layla will use it (letting her know Layla already knew how to hold it), and letting her know things she could do - like drawing on her granddaughter's back and having her draw it on paper - to work on skills. I felt very OT-ish giving the grandma these instructions and it was really neat.
When you think about Layla's shyness, and what apparently amounts to a lot of sensory processing problems and fear - you have to wonder a little bit about the chicken and the egg. Did her fear of everything cause her shyness since she held herself back, or did her shyness keep her from ever exploring, thereby fearing new things? My guess is that it's both and that primarily her unstable sensory needs have caused her to hold back. She needs to work on social skills and tolerating others but I think merely tolerating me - more or less a stranger - and me trying to encourage a little playfulness from her - is enough for now.
I don't think I am particularly talented compared to other OTs in most ways, but I think I have a much stronger grasp of playfulness than even most pediatric OTs - in terms of figuring out creative ways to be silly or bizarre in a way that appeals to the child - so I have a strong hope of encouraging some new forms of playfulness with this little girl in the next few months.
I wonder if I'd get in trouble if I let the little girl put her hands on the copy machine so that she could paint HER nails next time on the paper - (using marker on her copied hands) - hmmm. Okay anyway, I had a wonderful session with this little girl and it was primarily due to the suggestions my friend gave me. :) I think she may be favorite kid to work on because she has so much room for growth.
I have a lot of issues myself with visual perception, sensory processing, fear...and so again I see a lot of myself in her and have a lot of compassion and empathy for her fears...and want to see her one day be able to run and jump and have fun with friends.
Okay. This was a crazy day starting from this point on, the schedule kept changing every few minutes as kids would not show up, or other kids would show up unscheduled or unexpected, plus we had a new OT grad (from UT), come by for an interview, plus we have the COTA out of town, plus we have two PRNs coming in to help out, Vanessa and Karen, plus we have lost our old tech but have a new tech, so things were INSANE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! INSANE!!!!!!!!!!!!! INSANE!!!!!!!!!! Luckily at this point I've now become familar with almost all the kids so it's not so much as a shock when things get moved around.
I next took on my little nonverbal kid that has gravitational insecurities and hypotonia and just needs work on basic EVERYTHING. The first few times he came he wouldn't even get in the ball bath and now he loves it - well, I've basically seen him from session 1 - bearing in mind I've only been here 3 weeks now - and I've tried to get him in the hammock swing in the door a few times, but he never tolerated more than say, I don't know, 15 seconds, before whimpering to get out. I took advantage of the fact he now LOVES the balls, and LOVES throwing balls through a tunnel, and that he had just watched another child swing happily....which is great incentive. I put him in the swing and immediately dumped a load of balls in his lap and held up the tunnel. He was a little unsure at first but eventually ended up swinging happily within the hammock, throwing balls, smiling and giggling, for about 10 minutes. It was AMAZING. A big deal and a big turning point. :)
Ok let's see...we had a kid with Down syndrome show up and he had a joint session with a boy who has VP issues as well...what interests me is most of these kids do not have issues with each other....they all accept each other and play with each other to the best of their abilities. Nonverbal, autistic, Down, VP issues, ADHD...whatever. Pretty cool. I had a little trouble figuring out things to do with my severely ADHD kid in conjunction with another kid - I get a little stumped if I come in partially through a session or if there is another kid in the works.
A kid named hmm Bob showed up that I haven't worked with before - he is like 3 and he is afraid of EVERYTHING and basically cries all the time. His goal mostly involves just tolerating ANYTHING and being away from Mommy. At one point we got out busy bugs (cute colorful bugs like dragonflies) and he was terrified. Afterwards I had a talk with Mom and was letting her know how scared he was and she was telling me about this fake spider her husband brought home because SHE is scared and how he was terrified too when he saw it because he knows how she responds- we talked about, obviously I am paraphrasing here, how her fears are legitimate and obviously it's ok to be afraid of them (I am too), but pointing out gently that her fears will affect HIM (and teach him to be afraid too), so that might explain HIS fear of these bugs - she wanted to know if it was just spider bugs or everything - I told her it was all the bugs in general, but that he was probably generalizing spiders to include all bugs remotely like it - and that maybe she should consider getting some cute little bugs to play with, to show him there is nothing to be afraid of. The more I spend time with parents the more I realize the power my scrubs has - they treat me like I am an expert - so I need to be careful what I say or do.
Okay I only want to talk about one more big thing. The severely autistic kid I had a good session with the other day, is having medication problems, and is on a patch that, when it wears off, sets him off nuclear. He had an okay session although was agitated about wanting his mommy, although when it was time to go and surrender the spongebob toy, he FLIPPED OUT. He was screaming and throwing himself around and it was all my OT could do to keep him from hitting his head...this is a tall boy. She would hold him in her arms firmly to restrain him and he would calm down and stop moving, but when she would finally loosen her grip slightly, since historically he'd be calm at this point, he kept going. After about 15 minutes of repeating this, we finally took him out to his mom. She immediately put him in a restraint that was clear she had practice - she said he had a behavioral plan and so she had undergone training - she wrapped his arms around himself like a straitjacket, put her knee against his bottom, and pushed him against a wall - not meanly, but gently, and solely to immobilize and calm him. He was immobilized against a wall and it was clearly calming to him, although if she eased up at all, he'd start flipping out and kicking his feet again. She had to hold him against the wall in this position for a good 10+ minutes, and was telling us they needed to go back to the neurologist to discuss this, as this is now what happens when the patch wears off, which is obviously unacceptable...it was pretty amazing. I was actually really glad to see this restraint and while I hope I never need to use it, it was good to learn.
By the time we finished with him and I did some cleaning of the absolutely chaotic office - remember it had been a ZOO - it was almost 7:30pm. I met Allison at the track near the dorms and we walked a while and talked about our days....I got home around 9pm and was exhausted ....and realized that the only thing I had eaten that day was my bowl of yogurt with cherries and almonds at 1pm. Oopsies. LOL. I'm a little overweight because I eat when I'm bored - and I was bored a lot in June - plus I sat around a lot. But I have the opposite problem in general - when I'm busy, I forget to eat until I get sick from low blood sugar. Today I was so wired that adrenaline kept my sugar from dropping too low until I finally chilled out. So I had a tomato cheese baguette around 11pm for dinner. I'm slowly losing weight I gained in June since I'm on my feet all day long and don't eat that much.
I got frustrated because I had so many e-mails and Facebook messages I wanted to respond to, many of them from strangers about OT, plus I really wanted to blog about my days, plus I wanted to clean, but I was sooo tired. I finally got to bed around midnight without hardly doing any of that stuff. Oh well. I got the call Friday evening to meet in the office around 930pm and that we'd be done by 2pm. Great. (These hours sound cool, but remember that I've worked overtime like every single day (without pay of course since we work for free and actually pay tuition for the honor of it), plus we work 10+ hours on Tuesdays and normally Thursdays, so it's not as awesomely little as it sounds). Anyway, we're going to Oxford, Misssippi for the day. I didn't realize how far away this was - it was almost 200 miles roundtrip. A speech therapist wrote down directions and unfortunately messed them up slightly since it was from her head - so we got a little lost - we left around 930 but didn't get there until a little past 11amish.
Then we did an eval with First Steps people + some speech therapists at Ole Miss, of a little boy with expressive aphasia, following in the footsteps of his older brother. Because the speech therapists didn't have a lot of experience with First Steps and therefore hadn't done evals with OTs before, there was some confusion over assessments, and so we didn't get done until 12:30pm. Oh, let me add in that I had had a bad headache from the middle of the night and it hadn't gone away, so I was in a lot of pain and definitely not feeling up to being very um, mobile. Anyway, the first steps people wanted to grab a bite to eat with us, so we ended up eating at Chili's. Unfortunately we got a waiter that probably could have benefited from First Steps as a child, as I'm not sure we've ever had a waiter be so slow to catch on. I ordered a cup of soup, a piece of corn on the cob, and a chocolate shake for lunch...I had to ask about the shake at least 4 times. Then he completely screwed up our easy bills...etc. And it was sooo slow. Good thing he was pretty, but he had odd mannerisms and we ended up being at this place forever. On the plus side, the first steps coordinator re-taught me the method of calculating a child's age in months based on the current date, which can get complicated (like an eval on 7/17/2008 for someone born on October 20th). You can also just kind of figure it out on your head/fingers, but I wanted to reknow the formula for it.
ANYWAY then we went back to the health department so that they could give my OT the evals/forms on the kids we'd be treating once a week from now on since their OT is leaving...so now we will be doing Oxford once a week too I guess. That's a looong drive, luckily an easy one. At this point though, it was ridiculously late. We got back into town at 430pm instead of 2pm. :( I had promised Patric, a 13 year old boy I try and take out for fun every once in a while, that I'd get him at 3pm, and I had to switch that to 430pm. He has been asking me when we'd next do something for a LONG TIME, and so even though I was tired with a bad headache and frustrated with being 2.5 hours late, I didn't want to let him down.). Note: I asked a friend what she thought a 13 year old boy would like to do, and her answer was "You", LOL. Luckily he is immature enough that I don't think he's quite at that point...hmm. Anyway, I picked him up and we went downtown to eat sushi, play at Jillian's, and have ice cream....and he has grown a lot lately and I dunno, I did get to think he is starting to get to a point where he likes girls and likes me...but not in a creepy way at least. It was sweet. We played a lot of air hockey and I kicked his butt even though I tried not too - I have really good reflexes.
Around 715pm I dropped him back off at home and headed to a Vietnamese restaurant to meet my friend Doug...and I talked to him about my little girl and the lines and how I wanted to think of fun ways to work on connecting lines...then we went to my OT friend Kerri's and Brent's and they had their friends Eric and Melinda there so it was the six of us...we hung out and played games....but I was sooo tired that I spent most of the night lying on their carpet as if dead. We played scattergories and I agreed to play only if I could come up with whatever words I wanted because I don't care about points and I have very bad recall, so coming up with ethnic foods that start with "W" for example, isn't going to happen. I just make up things like wenchiladas. Eventually I got to the point that I was wandering around like a patient with dementia as they played their game...and finally left around 11:15pm because I was completely and utterly useless, period. I love being so busy in some ways because I am thriving mentally and physically (minus the headaches and such), but my exhaustion is pretty complete by the end of the day....and things have been extra tight because I'm trying so hard to see Doug a lot since he leaves Monday for England again to finish his dissertation.
Now I've been writing for several hours and once I get done blogging today I'm going to take a nap and THEN dance I think, LOL...I'm tired again. On Monday we go back to the new clinic but we only have two kids as far as I see, both of which we have seen before and I love, and then my kids in our normal clinic are all familar except one little kid with a mohawk but I'll read up on him....only one new kid, shouldn't be too bad of a day. Plus I've enjoyed meeting Allison after work at 6 or 8 or whenever I get off work to just walk around the track and talk about our days for a little while, and since she lives so close it's really convenient since by then I'm ready to collapse. It works best if I don't ever even get home until 9 or 10pm, because if left to my own devices I'll end up napping inappropriately. I always thought working would suck out my soul, but I've discovered NOT doing anything sucks out my soul worse - being busy all day, then seeing friends/working out, then collapsing, is pretty awesome, health-wise, for me. LOL.
Okay...the COTA is only gone one more week, plus I am getting to know like all the kids at this point, plus we might be hiring a new OT, so I'm thinking that life will get easier if I can just get through one more week of chaos...not that the chaos will stop, or the drama, but it should improve at least. My goal for this week, discussed with the OT on our drive back from Oxford, is to do an evaluation by myself. I'm already treating many patients a day (a full caseload in the sense I typically see patients nonstop), so with the exception of maybe starting to see two kids at once, I don't think there's much to add onto, treatment wise. And knowing the chaos of work, probably starting this week once I do my first eval, I'll probably end up doing most of the evals!
Since I've never been a Level II student before and my OT or clinic has never had a student before either, I'm really not sure what's normal...like I don't know if having a full case-load at 3 weeks is normal or not, but since there isn't a lot of documentation, and since its basic developmental peds, it seems pretty okay, I guess.
I do love my OT and the clinic and the people and the kids and everything...the chaos is a little much, but I'm proud of myself for keeping my frustration levels, fatigue levels, tolerance levels, stress levels, to an acceptable level...those of you who know me well or knew me in previous years, know how HUGE HUGE HUGE HUGE HUGE of an accomplishment that is for me, since historically I was an anal stress-filled overly prepared rigid freakoid :) Now I'm just a somewhat stressed freakoid, woot woot. LOL