Friday, July 29, 2011
Monday, July 25, 2011
Thursday, July 21, 2011
That sounds like a lot of work. But I think it would be good to do. Does anyone out there already have a contract and/or social story for OT aimed at younger ages?
My friend sent this article to me (a long time ago :x) with the enclosed commentary:
Making a cloud with rainbows
maybe this one too...
and I think this one is beautiful....rose petal drawings
and this one for Halloween...
Wednesday, July 20, 2011
I spend a lot of time while working trying to make sure I get the lingo down and know what I am talking about. I write myself a lot of cheat sheets with things I observe/read that I want to use in the future. I don't do a great job of organizing it though. But here is an example cheat sheet from when I worked in adult physical dysfunction last year. Now it's all alien to me since school OT is a whole other area! But when I read some of this stuff it reminds me how complex OT can be. :0
PS: None of this should be taken as advice down below - it could be wrong for all I know, and it's certainly all out of context. Just showing all the complex terminology and thought processes etc. I do notice when I read through this the lack of occupation-based terminology. Oops. ;)
PS2: I am down to under 100 new mails. That's why so many new OT blog posts lately, I'm getting close to everything being cleaned out. :)
Abduction on sidelying
"composite digit flexion"
"Pt also demo intact LUE sensation to SWM 5.07 for protective sensation, however absent 2 point 1.0cm discrimination along L median nerve distribution/medial cutaneous nerve"
OT then applied gentle PROM to L digit flex/extend with differential FDP/FDS tendon gliding and pt instructed in joint blocking.
Increase facilitation of normal tone, neuro-re ed out of flexor synergy, activation of paraspinals and abdominals, long duration stretch with ext/sup patterning using deep tendon inhibition techniques, RUE through PNF D2 flexion patterns, OT maintaining flexor synergy inhibition points of contact for increased AROM while pt moved through PNF patterns
Sliding board with wedges
Straight cane to activate external rotation with ace bandaged hand
Scapular mobilizatios – elevate, me do it, then u try to help
Supine uphill, cocontractions
Do some oscillations on shld while supine, quick approximations as well, externally rotate thumb while trying to do elbow ext
Prone on elbows or table top
Closed chain/open chain
Lumbricals – tend to get clawed?
Intrinsic plus/minus positioning
Transfers to graded height surfaces
No proximal activation palpated
Performed closed chain task
Dynamic reaching over weak limbs?
To improve postural stability, stand on variety of unstable surfaces
Try to self-correct and improve postural integrity, perturbations –v estibular
Change velocity, angle, distance
Unilateral UE release to challenge dynamic sitting balance
Air splint for neutral warmth to decrease tone
Max A to find initial placement on L
Unilateral UE downward reach and hip flexion needed for LE clothing management
Intermittent hands on assistance to maximize full elbow extension, keep postural integrity
Lowered concentrically with control
Cross friction massage
FPL – same, only move IP of thumb
FDS – same, to move PIP
Isolated FDS, FDP, FPL tendon FDP – hol down palm up so can only move DIP
Scapulohumeral rythym discoordinated
Ulnar nerve paresthesias, 2/7 for 0.5 2 point discrimination
Stereognosis – no vision tactile search
Intrinsic: digit abd/add, interosseous lumbricals, so do pull apart fingers with resistance. Strengthen intrinsic plus position
Straighten elbow, FDP flatter stretch at IPS????????
Follow ulnar nerve tract up C8/T1 (brachial plexus)
Scaption to decrease impingement
Thumb up: coracobrachialis
Supination: biceps bracchi
Ulnar nerve glide ex: elbow extend etc
With OT correcting techniquers
CMC joint tightness
Resistive L digit extension
Difficulty with voluntary movement of thumb and digit opposite and lumbrical grip
Contract – isotonic
Hold – isometric
Agonist – pattern with limited motion
Antagonist – muscle shortened that limits range of agonist
D2 ext: ext add, int rot, flex abd ext rot, seatbelt side on top, cross on bottom
D1: flex/add/ext, ext/abd/int, cross on top, side on bottom
PNF – proprioceptive neuromuscular facilitation, increase response of nm mechanism by stimulating prioprioceptors, fl/ext, abd/add, int/ext R, rotary component, balance of antagonists, sag, front, horiz
Trophic changes – ie swollen shiny skin and nails with ridges, sign of CRPS
TENS : transcutaneous, sensory to decrease pain, no visible contractions, bipolar 2, quad 4, crisscross pattern, black delivers shock, red grand/receiving. Further apart pads, shallow, close together deep. IFC – inferential current,
Ligaments – frozen shoulder, distraction, rythymic stabilization
Facilitate motor return
Respiratory rate – count number of times chest raises
BP manual, valve tight, pump up past 180, slowly release, listen to brachial artery, first and last heartbeat
Try to normalize movement patterns
Media positioned to facilitate BUE
For improved proximal stability for ADL tasks
Performed to improve BUE extensor strength
QD – once a day
BID – 2x a day
Cross tendon massage, subscapularis massage from axillary angle
UE assisted pelvic elevation
Shoulder capsular massage
Interosseous mobilization – supination and pronation, go up and down, radius and ulna
Neuro – don't go past pain, ortho- go past pain
Pain increases tone so only go to tolerance
Don't stretch hypotonic
Performed eval and pt has potential to increase functional skills, need to redo home program with 2 visits.
"composite flexure contracture"
Viscolas Flexigrip Hand exerciser
Vision: contrast, geographical vs spatial, inattention, poor vision, eyes jump/nystagmus, boundaries ie red tape to red tape
0---- bp, then 0 seated, standing etc
Dissociation of body and limbs
Active assist bow activity, bow positioned to inhibit compensatory R shld abduction and facilitate flexion in slight scaption. Occasional manual assist to inhibit compensatory R trunk lateral flexion.
Media positioned to promote RUE AROM in diagonal patterns and improve standing balance. Min A to maintain dynamic balance during task, ball placed to provide proprioceptive input to RUE and resisted trunk flexion, to improve postural integrity, decrease compensatory movements, improve tone for increased efficiency with ADL and mobility tasks.
Stickler's syndrome: decreased visual acuity, nystagmus, increased risk of retinal detachment and amblyopia
Swivel spoon/wrist splint, steering wheel covers, HEP tendon glide, nerve glide, gentle strength, rubber band extension, towel crumble
here were some of the ideas I had written down (some more occupation-based than others but just things to prompt my brain) while working in inpatient rehab....
PS: Belly dancing/fencing were two things I was into...belly dancing is GREAT for hip/core work (find just a basic video on youtube and they can work in the parallel bars, if not shy about it of course) and fencing (with foam swords) if you use the proper stance (google that too) is great for balance and strengthening/stabilizing lower body while also incorporating upper body. :)
|Lean on wedges to work on stomach|
|Wedge ramp, roll ball from one to another on wedge|
|Place paperclips under bottom, raise up and take away|
|Sit on BSC, raise up place tennis balls from either side|
|Dowel ladder, put cones on it or use weighted dowel|
|Lie on back, reach up and back for items|
|Ball or bolster rolling up and down wall|
|Partial sit to stand from mat|
|Pegs on vertical surface, place pegs in, maybe patterned|
|Theraputty hand exercises|
|Airsplinting to reduce tone in elbow|
|Velcro rotators for hand manip|
|Pick up rice pieces|
|Stack tiny cubes|
|Bend knee back, kick ball|
|Abacus with foot to slide beads|
|Hit ball with weighted dowel|
|marching in place|
|UE assisted pelvic elevation|
|scooting on mat|
|lateral weight bear for peg shapes on vert surf|
|sort cards by suit|
Tuesday, July 19, 2011
Canes: Sometimes the person with low vision is not quite at the level at really needing the white cane, but use it anyway because it warns other people to be careful/aware around them.
Reading: Many people with low vision can read, however the difficulty may be in sustaining it due to distance from print, nystagmus, general ocular control, etc.
Nystagmus: Sometimes a head tilt/turn helps quiet the jumping of the eyes and maintain optimal sight.
Here are some things I wrote down that I no longer have any idea what I was referring since it's been like three years :x If anyone wants to clarify any of this, go right ahead.
"achromats" = not people first language.
Fans - shadows
Grating acuities, teller acuities, etc, "Facile"
Stable or progressive vision issuesSensory channels most used - Learning Media Assessment.
Braille: A lot of kids actually read Braille with their eyes! If a kid has visual sensory preferences (even with low vision), it may mean Braille is not a great choice. A tactile child will benefit from Braille more.
Alright, I'm headed out to a store, so I need to stop writing this post - so it's unfinished from this point down - I'll try to come back and edit it later today.
all might have same diagnosis but want different choices .Some kids can see letters but not read due to saccade issues.
Visual function, with rehab, can lead to functional vision
Albinos - 1/2 fibers dessicate at optic chiasm. problems with stereoopsis? Need orientation and mobility - problems iwth depth perception
Nyctalopia - in to out, transitions - ie bright playground to normal classroom
Try and maximize remaining visision
Brain fools us - we think we see all around us but not raeally
Sighted kids rely on visually impaired kids for freeze frame data - complete change from before!
I didn't start studying nearly as early as I should have, but I used 3 sources: TherapyEd book & review course, NBCOT book + online practice exams, and friends.
If you can afford it, take the TherapyEd review course. If money is an issue, it's probably still worth it IF YOU HAVE TROUBLE TESTING (the cost of that course is cheaper than re-taking the exam). If you are a strong student, you can probably get by without it.
I liked the TherapyEd review book that came with the course. I basically memorized the vast majority of the book. You need to be able to spout off the information, NOT just "recognize" it. I did flashcards, not so much to actually use, but to help me concentrate so that I learned while making them. There is what, like, thirteen chapters? So depending on how slowly you study, try and give yourself a few days for each chapter if at all possible. DON'T SKIP ANYTHING. I really only glanced briefly at statistics/research/management, and I wished I had looked closer. Everyone's test is different, but everyone's test will most likely include a little bit of everything. The more you know, the more likely you'll pass, obviously, right?
Now, the TherapyEd questions are kind of weird, I admit. Long and oddly worded. Still good practice. And it has lots of CST to practice with.
The NBCOT book was much more like typical NBCOT questions, although oddly enough, the book didn't have any example CSTs...those new clinical simulation questions. (I ALWAYS confuse the words stimulation/simulation).
NEW NOTE: All this may have changed in the last few years with new editions!!
I HIGHLY recommend purchasing the NBCOT online exam that is 100 questions. According to a classmate who researched it, there is like a .9 (ie high) correlation between your score on that exam versus the real thing. I don't have the evidence though. Also, one of my classmates went up FIFTY points from practice to real thing so I guess um, well, ....anyway, it's still helpful to see how you do on that online exam. The other things you can buy I don't necessarily recommend...if you can afford it, great, it helps with confidence ...remember you cannot necessarily go back and see the question though...and answers aren't always given I don't think. So examine everything carefully the first time, and jot down notes as needed.
My favorite study questions had to do with psych....here is a (very very) brief psych med overview. Like I said, it may or may not be on one of your tests, but you should know it regardless! It seemed like each study book had this same information in it.
Akathisia = restlessness, urgent need for movement, typically a psych med side effect.
(This is like my favorite word!)
Tardive dyskinesia = almost constant movement, more chronic and serious, does not go away, and is result of years of heavy psych meds. The movements are more writhing with a lot of oral motor involvement.
Make sure you know the difference between the two types of movement. :)
MAOIs = drugs used for depression. You have to be on a restricted diet on these medicines because of an amino acid blah blah - so they like to ask diet questions. They can't have like, pickled, smoked, cheesy things...and one of the first signs of toxicity is a headache. Your patients, whether you work in mental health or not, may be on this type of medication, so make sure you know the reasons for the special diet, etc.
Photosensitivity = lots of psych drugs cause people to be more sensitive to sunlight than normal. If you are doing psych activities/groups and it involves being outside, there is a good chance you'll need to remind the clients and/or be prepared to deal with that side effect.
***As far as I can tell after re-reading this repeatedly, I have not said anything inappropriate/proprietary....if anyone disagrees, please let me know. My intent is to share advice, not do anything illegal!! :)
Monday, July 18, 2011
I found these three things that might help me figure out a Staples button hack. I want it to say "help" instead of "That was easy!". By the way, kids LOVE the Staples button and consider it a real treat to be able to hit the button after an activity. Even if the activity was actually somewhat frustrating, the kid gets a ghost of a smile on their face after hitting the button. The only problem is they usually try to hit it like six times in a row.
I have a child who doesn't like to ask for help....I wanted to make a Help button so she could hit it for fun. Seemed like a good idea. Only problem is, I'm not exactly handy with a drill so these hacks seem a little challenging for me. But wanted to throw out the idea of hacking out these buttons for basic communication needs or to be silly.
Other alternative....does anybody know of similar buttons you can buy to say whatever you want? I am sure there are OTs and/or SLPs out there working with AC who know way better than I do.
B) Writing a poem on the board with some words that are mispelled or out of order, see if they can correct as they copy.
Anywho, something I do with my kiddos is called crayon resist...a way you could make it easter-y (maybe next year!) would be to write on boiled eggs before you color them with white crayon or some type of wax, then dye the egg. The crayon/wax will resist the dye leaving lighter spots. I figure you have to write softly on eggs! Just an idea, hope it made sense!
also writing on tissue paper? or I'll have kids draw with markers on coffee filters and use a squirt bottle to spray the paper, then let it dry and either cut it into something neat or turn it into a butterfly or flower with pipe cleaners. -- both tissue paper/coffee filters rip super easy and the kid has to take their time.
Or drawing designs on aluminum foil with sharpie is pretty neat looking and you have to be gentle!
Like I said I'm not an OT just throwing some fun ideas from my experience with kids :)
I use a mechanical pencil, sand paper, tissue paper, writing while a Grip-It shelf liner (liner that is placed in drawers with small holes) is placed under the paper. This all gives feedback as to how pressure to exert.
I also wonder if a weighted pencil would also help?? Any thoughts?
I got contacted by Dycem and they will be sending me a few products to review and I also have a book to review! I am really excited! I love reviews!
I am in Alabama one more week - back to San Diego next Sunday. Fun times in the South.
I am trying to get up the energy to go work out! One of my biggest, biggest issues is almost constant low energy. Bleh.
Well, this was a pretty worthless posting, but I wanted to say I am back to having wireless, back to responding to blog emails etc (I went from over 1,400ish to only 210 in the past two weeks). Another goal of mine - although not this week - is to write an article for OT practice about Colombia!
Sunday, July 10, 2011
As always, try any of this at your own risk! Consider insurance of your work, liability issues, etc.
Mail 1: Would they like outdoor magazines? Would your organization allow hunting and fishing magazines? Can they accept them if they are free? There is a forum called Georgia Outdoors or Georgia Outdoor Network - can't remember right now. If it didn't upset your bosses you could join it and ask for magazines, I think you would get a bazillion.
Also could you take patients on field trips? Shooting ranges often invite special needs shooters in for free days. I don't know but I bet there are a lot of ranges in GA.
On simple stuff, the laser taped to the hand weights is a really good idea. LEDs could also work over a short range.
1. On the weekends go to the various car dealerships in the area. Get brochures of trucks, SUVs,cars, everything. You can cut up the catalogs, glue the pictures to index cards, and use them for sorting activities, guessing games (what kind of car is this?). I bet you could even come up with card games.
You are in the heart of NASCAR country. You could also do the same with drivers, racing teams, cars, factories.
You could also do the same thing with football teams.
2. Go to Walmart and get a couple of the Popiel Pocket Fisherman fishing rods. If y'all don't have the funds for buying stuff, I bet you can ask among the employees (Do y'all have an on campus BBS for lost and found, want ads, etc?) for a couple of old fishing rods. Tie a washer or other weight on the end of the line. Go to food service, get some large buckets, like pickle buckets. Let the guys cast the weights into the buckets. Sort of like fishing. Maybe a better outdoor, springtime activity.
3. Get a couple of old golf clubs (putters) and some big cups. Put put time.
4. Get a large piece of poster board and about two dozen large steel washers (about 1 to 1&1/2 inch diameter). On the poster board mark lines every five inches. Put designs on washers such as there are 6 different designs or colors on four washers each. In other words, you come up with 4 red washers, 4 green washers, etc.
Place posterboard on floor with lines parallel to wall. Have participants toss washers from appropriate distance. Person with washer closest to wall wins. Can be done standing, sitting left or right handed, etc. Watch this one though - chance of gambling occurring.
NGBRI= Not guilty by reason of insanity.
Pts = patients
Hx = history
SC = spinal cord
CP = cerebral palsy
A former classmate of mine (class below me) wrote this to me a loooong time ago about one of her rotations (she wrote the first part to me on FB, I responded and asked if I could share, then she shared the discharge status part. It took me over a year to finally post though):
The discharge status of the patients at XYZ (my current facility) depends on their judges verdict, how heavy of a sentence they hold, how long they have resided at the facility, and how stable their behavior has been over the last year (among other things). Someone who has committed first degree murder will definitely be residing here longer than someone who has been charged with simple assault or battery. Discharge options range from group homes to nursing homes or being released to family. If a pt has a hx of violence nursing homes will usually not accept them and they have to qualify by other means as well such as different physical disabilities (Low vision, SC injuries, CP, ect.) Many of the pts have HIV from extensive hx of IV drug use and their sexual backgrounds. If this is the case, their only option for discharge is basically being released to family members even if their behavior is exquisite. There are many sad, sad cases...and even though I was very nervous in as my rotation commenced (and still am at times) I will definitely miss some of my pts and I hope I have made a difference in there lives.
MY (garbled, as always) ANSWER, slightly edited as well:
I am so sorry you had a bad experience in your clinicals. That can really mess your brain up, to see burnt-out and/or poor therapists. I agree it is a challenge that nobody knows what OT is and not only that, it's impossible to explain quickly. I hate being asked what I do!! Because there is no easy response. But at the same time I do love what I do!
Being an OT versus OTA is a big difference in terms of feeling empowered, I think. If you have a MBA you definitely need to be at OT level, and after going through OTA school you definitely are a very strong candidate and will be miles ahead of many of your classmates with your practical knowledge. Now you can add in the theory. :)
Working in pediatrics might also be a better fit and make you feel differently. Such a massive difference. Although it may be tiring to work all day with kids then come home to your own.
Okay, to specifically answer your questions.
What are the biggest challenges in this field?
Do you feel like you are making a difference in the lives of the kids you work with?
At times yes. It depends. Some kids are just hard. Other kids you will say wow, I made a difference. But it depends a lot on YOUR style and ability to interact with family, other disciplines, etc. If you are a typical school OT for example who pulls the kid, treats them, brings them back, and doesnt say anything to anybody, then um, you probably wont feel like you made a difference bcause you didn't. 30 mins a week is nothing. But if you are proactive and try to really talk to parents, talk to family, look at the child's function within their environment and focus on that....yes, you might feel you made a difference. At times its frustrating. Honestly the ahrdest part of working with kids is the PARENTS - some are great, others are either overly or underly involved. Yes I am making up my own words.
Is there still a misunderstanding/confusion in exactly what you do?
Do you feel the profession as a whole is respected?
What do you dislike about the field?
How do you get away from people thinking you sit with a patient and a pegboard?
Do you still think it's a great profession?
Overall I think its a great profession to go into - pays pretty well, very broad so you can essentially change professions within same field (ie adult phys dys, peds, hands, etc) if you get tired/bored of a certain area, or just need flexibility. Its a good job to have with kids as you can choose a job with no weekends or nights and/or part time, and nobody dies if you dont see them. :) I think if you are cut-dry and don't want to deal with all the issues facing OT, then maybe PT or SLP is a better idea although you probably dont meet their educational criteria AND they of course have their own internal issues. I love OT.....it was the right fit for me.
Basically it's all about what YOU make of it. You will encounter plenty of bad apples and plenty of LOVELY apples (are you loving my midnight analogies?). Seek out the good, work hard, and you will rise to the top....don't let the bad ones bring you down. I sincerely hope you are planning on doing plenty of observation in pediatric settings (and other areas)!
Sunday, July 3, 2011
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Saturday, July 2, 2011
One on "Watch how you hold that crayon"....another possible re-post but this time I am deleting it from my inbox!! This one by NY Times on pediatric OTs working with handwriting etc. A slightly snarky article but still interesting.
An article on sensory processing disorder in Time magazine from a while ago. This may be a re-post, I can't remember. I'm still going through old mail. Down to less than 500. If you've written me and I've never responded, feel free to either re-send (if you sent it more than 2 weeks ago), or wait and see if it gets handled in the next 400+ mails I have left to go through. I had over 1380 old and 150+ new a few days ago, now down to 0 new and about a third of old mails, so I am glad...but still a long way to go.
Hi "OT Student X"
Do you mean like OT textbooks, or do you mean more normal books? For example, one of my favorite books is The Healing Heart about one of the first OTs, Ora Ruggles......I also like the Out of Sync Child.......and the Out of Sync Child Has Fun is the activity book that goes along with it.
See if this website works for you!
I browsed it and didn't actually see much of interest. There is a Chicken-Soup like book that came out that i want to read but I couldn't find it...if I do I'll post on my blog.
My OT friend Kerri next to me recommends any book by Temple Grandin - especially her older ones, her autobiographies - which I recommend as well. She also recommends Oliver Sacks books. Phantoms in the Brain by Ramachandran....
I personally like first-hand accounts....so autobiographies...of people with various disabilities like cerebral palsy. I go to the library to the health section and browse for what look like autobiographies. :)
It depends on how much you like to read and what kind of things interest you. There are certainly textbooks you could start with, but I am sure your school will provide you with a necessary list soon. I'd focus more on the fun stuff to get you excited. The first semester is actually kind of boring with a lot of focus on what occupation IS theoretically (at least it was to me...)....anatomy/neuro is fun according to Kerri ;) I disagree. ahahaha.
Hope that is a good start...
PS: Don't be surprised if in some of those first-hand books you get little mention of OT and/or it's somewhat disparaged! We have to keep working to get OT more respected. :)