Saturday, August 27, 2005

Car Seat Controversy?

We have received several phone calls in recent weeks regarding a controversial new 'research' study that was published on the 'Freakonomics' website. To view the article, click here.

The article states that the Fatality Analysis Reporting System (FARS) data shows that child restraint systems are no more effective than regular seatbelts for children ages two and up. There are several potential problems with this conclusion that need to be resolved.

First, FARS data only accounts for fatality crashes. The incidence of injury is far greater than the incidence of death in motor vehicle crashes, and this study doesn't address the way that child restraints may function to prevent injury in less-severe motor vehicle crashes.

Second, the 'study' has not been peer-reviewed. We encourage the authors to submit their findings to a reputable peer-reviewed journal so that it can be scrutinized appropriately.

Third, we are concerned that there has been no consideration for the fact that young children, especially the preschool population, may not STAY in place in a seat belt. I am not sure how well the authors know three and four year olds, but we are concerned about children climbing about unrestrained in cars. This could cause significant distraction to the driver and could result in a crash, where the children would then be totally unrestrained. So, even if car seats are 'no better' than seat belts, at least they keep the children still where they will not become a potentially fatal distraction.

ABC Therapeutics continues to strongly recommend the use of child restraints for all children.

Monday, August 22, 2005

thoughts on Pakistan

I originally wrote this on 9/18/2001 while I was feeling under assault from the constant media coverage of the terrorist attacks. I felt a need to revisit something positive relating to Islam.

I have been watching the National Geographic documentaries on 9/11 and that horrible feeling in my stomach returned, so I thought it might be a good time to dust off these old recollections.

"As-salaam alaykum," the gentleman said to me as he made his way slowly into my office, leaning on a cane and lowering himself slowly into the chair opposite me. I looked at him, hesitantly, not knowing the proper response. "It's nice to meet you," I said, extending my hand.

The man looked at me sternly and then said to me quite seriously and in a thickly-accented English, "This will never do. If you are to be the one who will help me improve my abilities, we will have to greet each other properly. When I say 'As-salaam alaykum' to you as I enter the room, you must return the greeting to me by saying, 'Wa alaykum as-salaam.' We will try this again." He got up out of his chair, left the room, and re-entered, saying "As-salaam alaykum."

"Wa alaykum as-salaam," I replied, misarticulating the words and tripping over the unfamiliarity of their sounds. A smile appeared on his face and he pronounced, "Now you can begin your work to help me. And I can begin my work to help you."

This mutual growth is not typically openly acknowledged by the person who is the one that is supposed to be doing the primary 'helping,' or by the person who is supposedly the one being 'helped.' But those of us that have been doing this for a while realize that this duality exists.

Mohammed was flown from Pakistan by his son, who was a doctor in the local community that frequently sent his patients to me. I received a phone call from the doctor one day asking me if I could do him a favor. I thought that this was a rather odd request from the doctor and could not begin to imagine what he wanted from me. "Please provide rehabilitation to my father," he asked. "He has had a stroke and he can not use his arm very well. I know that by bringing him here he will have a better opportunity for recovery." This began my relationship with Mohammed.

Most everyone in the U.S. is accustomed to doctors who have Middle Eastern, Indian, or Asian ethnicity. Many of our brightest and most talented doctors were born in other countries and came here to train, eventually becoming citizens. So even in the rural community where I lived, having a Pakastani doctor was not unusual or unaccepted. I suppose that when a person from another country immigrates that they do a lot to enculturate themselves, creating an ability to fit in with American culture, and even the local community. In this way we are sometimes not exposed to the richness of their native culture. Mohammed was not going to stay in the U.S., however, and so there was no reason for him to take on any habit or even superficial appearance of being American. As a result, all those that had contact with him grew in ways that were never before expected.

I was the only male working in the outpatient clinic, and he naturally believed that I was the Director of the entire organization. After all, who else would his son, the American doctor, arrange to have provide his rehabilitation? This caused quite a bit of turmoil in the building, as each time that he arrived he would state, "I have come to see Dr. Chris. Can you please find him for me, and tell him that his humble patient has arrived?" He would make this request of anyone that he saw, assuming that they all presumably served the purposes of being assistants to me. "Please go and prepare the room for me and Dr. Chris, as we will soon be ready to begin my rehabilitation." The *real* director of the agency thought it amusing when she was asked to do this. I probably didn't help by going along with Mohammed's perceptions, making requests of people that I really had no business making when he was there. It was all in good fun, and it actually did bolster the confidence of Mohammed. So everyone else went along with it too.

Mohammed recovered well. His ability to use his arm improved rapidly, and being immersed in a foreign culture re-affirmed his own connection to his native culture and religion. He would try to explain the Koran to me and spent hours telling me about his beliefs, and the faith that he had in Allah. "Not a leaf of the tree quivers, Dr. Chris, that Allah does not know of. He guides all that we do and has made all that we find beautiful in this world." He found such amazing comfort in being able to share what he knew with me.

"I knew that you would be able to help me," he said on the day of his last visit with me.
"Well how did you know this?" I asked, quizically.
He replied, quite seriously, "Dr. Chris, I knew that you were guided by Allah and that I was meant to come here when my eyes first saw your face. And although you have helped me be able to use my arm again, you have shown me that I have much to do in rehabilitation of my soul."

This seemed quite odd to me, as he was the one who spent hours teaching me about his religion, and I was the one who sat quietly and learned so much from him.

"Before I return home, I will grow a beard on my face again, just like yours. This is something that all men are supposed to do, and somehow I had gotten away from this custom. When I saw the beard on your face, I knew that you were a man of Allah. I am not shamed that I as a Muslim did not do this; I am now humbled, and am ready to return home."

Today, somewhere in Pakistan, I am hopeful that Mohammed is enjoying his day. And I am praying to God and Allah that he is safe and healthy.

Wednesday, August 17, 2005

Billy's world

I glanced down at the intake sheet on the seat next to me as I crossed high over the arching bridge and downshifted into the city. I was running a little late but thought that the house would be easy enough to find. I dialed the house and told the family I would be there shortly. The mother's voice was uneven and slurred. "The house is on the corner, and my street is between 18th and 20th," she announced. I was a little concerned, because I was not sure where else she thought I would look to find 19th St.

I entered the house by the side door, as instructed, and walked up a flight of deep and dirty steps to the second floor. I could tell immediately that the environment was not going to be pleasant. Cigarette butts were extinguished haphazardly and left on the windowsill next to some rotting food and too many flies. It was muggy and sticky just like the city gets in the hot August sun. "There would never be enough water to make this clean," I thought out loud as I paused to knock on the door.

The door opened into the kitchen and I immediately began scanning for cockroaches, but didn't notice any. I introduced myself to the three adults who were present: the two parents and a grandmother who had a nasal cannula on and a lit cigarette in her hand.

Someone obviously forgot to inform this woman that oxygen was combustible so I said, "Might not be a good idea to smoke with the oxygen on - could be that you will end up with worse problems than just needing some extra air." The grandmother responded in a surprised voice, "I can't believe no one ever told me that before," and I watched her take one last drag before crushing the lit end between her fingers and then placing the half-burned cigarette back into the pack. As she exhaled I watched the thick gray smoke curl past her lips and I felt myself exhaling also, probably in relief that nothing had blown up.

The mother of the child I was there to see was obviously mentally retarded. She had a speech impairment, one eye crossed in toward her nose at an impossible angle, and she held one arm postured tensely against her body in a contorted position. The father did not appear to be more intact than the mother; after telling me his name, he shared with me that he had epilepsy and couldn't read or write. The child I came to see, Billy, is a product of his environment and his genetics. He is almost three and he just began walking. He says a couple of words. He can only pick up items with his whole hand; he has not mastered individual coordination of his fingers. He doesn't know how to play with toys - even if he had any to play with. His parents are still feeding him pureed baby food because that is what the social services agency has been sending to the house.

The grandmother, only 50 or so, just had triple-bypass, has carpal tunnel syndrome, arthritis, emphysema, and had a back surgery a couple years ago. She has a physical therapist, occupational therapist, and a nurse come to the home to care for her. The daughter has a case manager from the developmental disabilties service agency and a counselor who works with her on parenting skills that both come into the home. The older child has a speech therapist and a special education teacher coming into the home. Billy has a speech therapist, physical therapist, occupational therapist, and special education teacher coming into the home.

As I counted off the eleven identified people that come into that home on a regular basis I was a little shocked and surprised that this was the best that could be done for this family. I don't know if they were better off for all of these people coming into this home. Maybe someone could have hung a calendar on the refrigerator - the mother has no idea when people are coming or even who is coming on a day to day basis. She actually has very little comprehension of time other than that her check arrives on a Tuesday. Someone could have helped them with scheduling or even consolidating and coordinating all the people who were coming into that home. Someone might have worked with them and taught them about cleaning the house or how to choose appropriate toys for the kids or maybe not smoking around oxygen. Some would say that I have high expectations.

As I was talking with the family the mother excused herself and got into a heated discussion on the phone. I tried not to listen, but at the end of the phone call I heard her say, "That apartment is not worth $350! For $350 you think they would be living in a PALACE!"

I spoke with the family about goals for Billy and they decided that they would like him to feed himself with a spoon. They also would like him to play with toys. I told them, "I can do that."

I asked the mother to sign my papers before I left but I noticed that she couldn't keep her printing on the small lines on my daily visit sheet. She did her best. I thought to myself, "they are all doing their best; I am just not sure anyone else is."

Smells tend to linger and hang in the uncirculated and oppressive warmth of darkened stairways in old apartment buildings. I sprinted down the stairs and into the sunlight and fresh air, only to see a brand new Jeep coming down the street (coming from 18th and going toward 20th) with several young teenage girls leaning out and cat-calling to a young man who was walking down the street. "NICE ASS!" they yelled to the fellow who I imagined should have been working and should not have been walking these steamy and grimy streets.

He stopped walking and flicked his cigarette into the street while staring at the Jeep. He held his hands out to his sides and leaned back into a pose that seemed to gesturally communicate his bravado and machismo. This greatly pleased the young girls who giggled and screeched around the corner. Life in the neighborhood, I guess.

As I drove back into the blandness and safety of the suburbs I considered the 75 cent bridge toll in a new way. I decided that it wasn't urban planning; it was class warfare and social engineering. You can't leave that city without paying, and I expect that someone somewhere realizes this fact. That 75 cents is the difference between those who have and those who don't.

That 75 cents is the difference between your world and Billy's.

Tuesday, August 16, 2005


There was a NY Times article today that outlined the degradation that people experience when they are admitted to hospitals or health care systems. I was a little bothered by the fact that this was presented as some type of news flash. I guess no one was listening over 30 years ago when Madelaine Gray talked about the same issue. This is probably too arcane for non-OT readers to find, but the citation is: Gray, M. (1972). Effects of hospitalization on work-play behavior, American Journal of Occupational Therapy, 26, 180-185.

So there are a few problems here. First, we knew about a problem over 30 years ago, discussed it and debated it, but here we still are without a solution. That is just inexcusable, and I wouldn't blame patients for revolting.

Second, how frustrating is it to be Madelaine Gray? I don't know if she is alive, and I doubt this could ever reach her ears or eyes, but I wish I could tell her that someone did hear her and that she was correct.

As for the Times article, it is around 30 years too late.

Monday, August 15, 2005

Back to work

There are so many things to do. I don't mean to have an exaggerated sense of what I am trying to accomplish here or elsewhere, but now I need to get myself motivated to do all the things that need to be done.
Despite being on vacation, I was thinking about things everyday; certainly, my brain did not shut itself down. I needed a transition back into work mode, so of course the John Deere came in handy. At first I didn't manage much beyond yard thoughts, but it got my thinking jumpstarted again.

Most recently I have been thinking a little about the moles in my yard. I don't understand why people are so upset about moles. They dig nice tunnels and I enjoy watching them scurry around when I cut the grass. I enjoy watching them run into their little mole-holes - and I am not compelled to ask them to leave. Actually, I enjoy the fact that they are there.

I feel the same way about the frogs in the pond. It gives me a sense of peace to know that they live in my pond, and that it is a good home for them. I found a couple more frogs in the drainage ditch in front of the house the other day, so I grabbed a net and caught them. The kids thought I was strange, because as I chased the frogs I yelled, "Come Simon; come Andrew; I will make you fishers of men." Simon and Andrew now live in the pond, and I do indeed feel like a deity that has created their world. My dog Autumn's pen was where the pond now is, but Autumn died - and the space was turned into a large hole in the ground. The water runs down my man-made waterfalls where frogs and fish now cavort.

There is so much to create. I need to find some turtles. When they begin their annual migration across the roads I plan to capture a few before they become road pizza, and I will give them good homes. I plan to call my turtles Matthew and Bartholomew. And perhaps Yertle.

I have a small fear that turtles will eat my fish. Hm.

The point is that there is work to do now, and things to manage, and I am back.

Saturday, August 06, 2005

Formula for success

I have been reflecting on the concept of work lately and am reminded of the Albert Einstein quote: If A equals success, then the formula is: A = X + Y + Z, X is work. Y is play. Z is keep your mouth shut.

I have done plenty of X.

This last week has supplied plenty of Y.

I am desperately in need of Z, and this blog is not helping.

Actually, because of my abundance of Y, I have been feeding my soul with all kind of replenishing things that will rejuvenate me for X. I read 'A Prayer for Owen Meaney' which was an interesting study in pre-destination. I also revisited some children's literature - mostly Lloyd Alexander stuff. Nothing clears my mind like finding my way back to a book that I read when I was ten years old.

My wonderful colleagues have been holding the fort down for me, which I will publicly thank them for here (THANK YOU!). A quick visit back to the office on Friday to beat back the Demons of Withdrawal and Paranoia was successful in showing me how irrelevant I truly was.

That is not a bad thing.

Anyway, the next week will be spent doing more Y. Maybe I will work on the Great American Novel too. Again, this does not lead me toward Z, but maybe the answer to Z is finding a way to get it all out of my system.

Stuff to think about.